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10868 SW 118TH COURT 0 00 cn 00 U) a 001 n 0 c 10868 SW 118"1 Court �� MASTER PERMIT PERMIT M MST2001-00534 DEVELOPMENT SERVICES DATE ISSUED: 11/26/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10868 SW 118TH CT PARCEL: 1S13413D-10400 SUBDIVISION: PENN LAWN ESTATES NO.2 ZONING: R-4.5 BLOCK: LOT: 032 JURISDICTION: TIG REMARKS: Construction of 168 square foot addition. No Ser�,ce Provider Letter required BUILDING REISSUF: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 11 FIRST: toy at BASEMENT, of LEFTSMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE. of FRONT: PARKING SPACES: TYPE OF CONS': 5N DWELLING UNITS: FINBSMENT: at RIGHT: VALUE: $15,220 80 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 16800 of REAR: 33 PLUMBING SINKS: I WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS LAVATORIES: DISHWASHERS: 1 FLnOR DRAINS: SEWER LINES: SF RAIN DRAINS: I CATCH BASINS TUBISHOWERS: GARBAGE DISP: 1 COATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES. MECHANICAL FUEL TYPES FURN c 100K: BOIL/CMP c 3HP VENT FANS: CLOTHES DRYER: GAS FURN>-100K• UNIT HEATERS: HOODS: OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCE& VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L IVSPECTIONS 1000 SF OR LESS: 0 200 amp: 0 200 amp: WISVC OR FOR: I PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 400 amp: 201 400 amp: 1 at WIO SVCIFOR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 500 amp: 401 500 amp: EA ADDL OR CIR: SIGNALIPANEL. IN PLANT: MANU HM/SVC/FDR: 901 - 1000 amp: 501+antp9•1000v: MINOR LABEL: 1000+ampIVoll PLAN REVIEW SEC!ION Reconnect only: >•4 RES UNITS: SVCIFDR>•225 A: >000 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSI RUMENTATION MEDICAL: OTHR: MVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 697.13 This permit is subject to the regulations c tnta-^d in the FOSTER,JAMES D/GALE A PHIL ROSE CONSTRUCTION Tigard Municipal Code,State of OR Spe,'lalty Codes and 10868 SW 118TH CT 17430 SW VIKING STREET all other applicable laws. All work will be done in TIGARD,OR 97223 ALOHA, OR 97007 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 Rap N: LIC 99839 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, Underfloor Insulation Plumb Top Out Exterior Sheathinq Inst Electrical Final Footing Insp Crawl Draln/Backwater Electrical;,ervice Low Voltage Mechanical Final Foundation Insp Footing/Foundation Dr, Electrical Rough In Gas Line Insp Plumb Final Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Final Inspection Poat'9eam Mechanica Mechankxal Insp Shear Wall Insp Rain drain Insp Issued By : L IAS' g " permittee Signature Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day 1_4 Building Permit Application City of Tigard Date received:/Q s Permit Address: 13125 SW Nall Blvd,'Tigard,OR 97223 Projcct/appl.no.: Expire date: City nfTigard phone: (503) 639-4171 Date issued: By: I Receipt no. Fax: (503) 598-1960 � Case file no.: Payment type: Land use approval• / I&2 family:simple Complex: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family J New construction U Demolition �4 A(I(Iitioti/alteration/replacement LI Tenant Improvement J I in �I,nnkl(tI/ hlIII J t ltl„I II SITE INVOIRMATI.OW Job address: I'L i I Bldg. nu.:— Suite no.: Lot: Block: Subdivision: Tax map/tax lot/account no,: _ Project name: Description and location of work on premises/special conditions: Name: 1.IN1 _ 03 ,. tom' Mailing address: to t (07 S W S ( � City: 2 _ State: 1.IP: •L Valu ruon oI (kr,ll .. ..../.�.........0............... $ Phone: - O$V INIV— [:-mail: No.of tkdrooms/baths...........•.............•....... Owner's representative: 'Total number of floors................................. Phone: Fax: F moil: New dwelling area(sq.ft.) .......................... —1 — Garage/carport area(sq.ft.)......................... Name: 1� (L-a) t~ Covered porch area(sq. ft.) ....•.................... Mailing address: e- Deck ares'ea. 1't.) ............... City: State: ZIP: Other structure area(sq. ft.)...................•..... Phone: I':I - E-mail: Commerciallindu,4trlal/multi-family: 1 Valuation of work..................................... .. $ Business name: _ � — Existing bldg.area(sq. ft.) ..........�........ ... �� G+u�T(t�,��'� New bldg.area(sq. f1.). •.•................:: ...... ------�— Address: -1({jo 1 y✓ ✓iv_m` 5T _ Number of stories .................I ......... .......... _ City: 9 &4 v 'te hi, State:pQ ZIP; 7007 Phunr; fax: Type of construction........................ ......... . - �� i•mafl: — �---- 9 Occupancy group(s): Existing: _. CCB no.: --- __ New: - -_— City/metro lie.no.: Notice: All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors Board unt r Name: 'r 0-7U"1 k ' 10 provision ul ORS 701 and may he required to he licensed in Ihr Address: 1 Z jurisdiction where work is being performed. If the applicant iti (yt A. State:0 LIP: 2-( exempt from licensing,the following reason applies: Contact person: ZjI/(; Plan no.: __— ---- -- 11 Name: S ISE 1L. j t nlact person: Fees due upon application ........................... $ Address: f 1 LiR rU( bate received: — city: _ State: LIP: Amount received .•.................•..................... Phone: Fax: E-mail: — Please refer to fee schedule. hereby certify I have read and examined this application and the Not all posilictione accela credit carne•pleaer call imiuliction rot more inb,nnatlon attached checklist. All provi Isoflaws and ordinances governing this U visa U Masters aril work will he cum)lied wi ether specified herein or not.�20 r'rediI-wd number _ .__L-- - (1 —_- ---------- Authorired signal le Name ml cardhmldrr as ehmvrn on credo cad Print name: �0.,..—��c'__ Notice:This permit application expires if's permit is not obtained t in I HO ays alter las been accepted as complete. 4401613(tSWCOM) One-and Two-Family Dwelling � Building Permit Application Checklist Reference no.: Associated permits: Oryu/Tigard City of Tigard U Flectrical U Plumbing J Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 9722 __- Phone: (503) 639-4171 Fax: (503) 598-1960 1 Land use actions completed. jurisdiction rt Ilrn i h n 1 ntieurrem recirk+ti 2 Zoning.Floud plain,solar balanic points,scisinl `- II.(Ir,ignation,111SIMIL (IN110,Cly — 3 Verification of approved plottlot. 4 Fire district---approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. _ 8 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-sine sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed il'co yright violations exist. -.- 11 Site/plot plan drawn to scale.The plat must show lot and building set hack dimensions;property c(mi•r elecation�(II there is more than a 44 elevation differential,plan must show conuour lines at 241.intervals);lut•aoon ut easenu•,u and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indict,+ I.lot arca;building coverage area;percentage of coverage;impervious arca;existing structures on site;and surface drain+,e. 12 Foundation plan.Show dimensions,anchor halts,any hold-downs and reinforcing pads,connection details ✓ent size and location. -- 13 Floor plans.Show all dimensions,room identification,window size,IocaU +I +I smoke detectors,watt,,,ica►tI.r. furnace,ventilation fans,plumbing lixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as Plexor 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,rxrl slope,ceiling height,siding material.footings and foundation,stairs. fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum ot'two elevations fur additions and remodels. [ tenor elevations must reflect the actual grade if the change in grade is greater than four Burt at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. _ 1 r, Wall bracing(prescriptive path)and/or lateral analysis plans.Must india.ate details and locations;I'or non-pruscri�ttivc path anal sis ruvide specifications and calculations to engincerinu standards. 17Floor/roof framing.Provide plans for till 1lo ors/roof ast mhlies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. _ I R Basement adad retaining walls. Provide cross sections and details showing placement of re.bar. For engineered _systens,see item 22,"f'sngmeer's calculations." _ 19 Beam calculations.Provide tw,)vets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any bcatn/joist carrying a non-uniform load. 20 Manufactured floor/roof trusty design details. _ 21 Friergv Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required t a IAiur or more.appliances. _ - 2' I ngineer'c enlculatlon4l.When required or provided•(i.e.,shear wall,roof truss)shall be stamped by an engineer or nlrhuccrt h :nu+I m I hrgon'Ind shall he shown to he applicable to flue project under review, M 1101411,1111 1 21 Five(5)site plans at,.required I'or Item 11 ahove, Site plans must he ii-1/2' I I"or ll* x 17". 3-I'wu C2)sets each ore required fur Items 16, 19,21181 22 above. _ 25 Building plans shall not contain red lines or tape-ons. �M �26 "Reversed"building plans must UnMt criteria outlined in the Pennit&System Development Io cument. r28 No"mirnlred building plans will IT accepted. "[)yawn it)scala:"indicates standard architect or engineer scale. _ Checklist must he completed betorc plan revlew start date, Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved loco dcpardr,:nr use only. 440-4614(s)rucoM) Electrical Permit Application Dale received: Permit no.: A, k City of Tigard Project/appl.no.: Expire date: t':r:,tTigard Address: 13125 SW Nall 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: 1 J 172faly dwellingor accessory U wmmercial/industrial U Multi-family J'Tenant improvement Nruction X Add ition/alteralion/replacemcr I i U Other: U Partial No 1 Job address: 7 ' C i �.G til Bldg.no.: Suite no.: Tax map/tax lot/account no.: Lot: Irick:_- Subdivision: -- -- Pro.ject name - I Description and location of work rm premises: '.tillll1:11 r'(I rl'11C n1 rirlflil�i'I1i 1111 r1ti�k't llull_ -- 1 1 Job Ito: _ 14r Mui Business name: F L Q L-Im M-( c- Description _ Qty. (c..) 7'olal no.fns r Address: c , - New rtsM-nual-single or multi-famlb per dwellingunit.Includes allacla•r1 garage. City: or2_o state:p2r ZIP: 2 Seniceinchrded: Phone: d (oa Fax I(xt0a g Zl E-mail: y fl.or less 4 CCB no.: 25 Elec.hos.liC.n0: Each additional 5(1U .fl.or rtion thereof p Limited energy,residential 2 City/metro tro tic.no.: I.uniteduner y,non-residential 2 Foch manufactured home or modW_.r dwelling Signature of supervising electrician(required) - hme Service and/or feeder Sup.elect.name(priIII) Limnsenn: Services or feeden-Installation, a11en11on or relocation: 2W amps or Ices 2 Name(print): 1µc rk{tj(.� ( o$TEl2 201 am ato!1! ampa 2 Mailing address: p , u� r 401 amps to 60(t amps 2 601 amps to I(x)0 amps 2 City; () Stale:dR. ZIP: 27770, Over two amps or volts 2 Phone: J-7o y 0 Fax: E-mail: Reconnect only I Owner installation:The installation is king made on property I own Temprrnry services or feeden- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelocatiun: ORS 447,455,479,670,701. 2W amps or less 2 201 amps to 4(x)amps Owner's si gnature: 2 _---- Date: 4((I l0 6(1(l am a 2 Branch circuits-new,alteration, Name: or extension per panel: — -- A. Fee for branch.ircuits with purchase of Address: service or feeder fee,each branch circuit 2 f ily: State: /.I P: 11. Fee for branch circuits without purchase / of service or feeder fee,first branch circuit-Pltonr.: � (�a.x: 1: mail 2 Eac Tidiiional branch circuit: Misc.(.Service or feeder not Included): — U Service over 225 amps-crnnnrercial U Hcaldr care lacduy Each pump or irrigation circle 2 U Service over 320 amps-rmingof 1&2 U Harardouslocauon Fachsign oroutlinelighun 2 fandlydwellings U Building over 10010 square feet four or Signal circuit(s)or a limited energy panel, U Sysicm over 600 volts nominal more residential units in one structure alteration,or extension* 2 *Ruilding over three stories U Feeders,400&nips or morn, •Jescri tion:_ U occupant load over 99 prrxons U Manufactured structures or RV parte Farh addNlonal htr ~�— U Fgreas/lightingplan U Other. peetlon oyer the allowable In any of the above: -- Per inspection r—�--�---�-- Submit_seta of plan with any of the above. IrveetigAtion fee _ 11w above are not applicable to temporary Construction service. Other NO All Judalictlons a cep,credo cards,please cell jurisdiction for,noir inramauon Notice:This permit application Permil fee.....................II U visa U MasterCard expires if a permit is no,obtained Plan review(at ,_ %) $ Credit card number -_ _ within I SO days after it has been State surtharge(BAF,) .... x res accepted a3 complete. TOTAI. .... ..................$Name of ca of r u non enx II cerrj 4404615 W00,1COM i ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED-RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy P-99................................................... $75 Oo 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 4 Audio and Stereo Systems" Each additional 500 sq ft.or $33.40 1 portion thereof Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular UGarage Door Opener' Uwel!ing Service or Feeder $90.90 2 Services or Feeders n Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation $80.30 2 200 amps or less El Vacuum Systems' 201 amps to 400 amps _ $108.65 2 401 amps to 600 amps _ $180.80 2 r Phw 601 amps to 1000 amps $240.60_ 2 C7 - Over 1000 amps or volts $454.65 2 Reconnect only _ $66.85 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Fee for each system.............. 375.00 .............................. Installation,alteration,or relocation $68.85 2 (SEE OAR 918-260-260) 200 amps or less 2 201 amps to 400 amps $100.30 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, F-1 Audio and Stereo Systems see"b"above. Branch Circuits Boiler Controls New,alteration or extension per panel a)The fee for branch circuits Clock Systems with purchase of service or feeder fee. ❑ Each branch circuit $6 05 _ — 2 Data Telecommunication Installation b)The fee for branch circuits without purchase of service Fire Alarm Installation or feeder fee. I $46.85 'j First branch circuit HVAC Each additional branch circuit _ $665 T7 Miscellaneous Instrumentation (Service or fender not included) r, Each pump or Irrigation circle $53.40 L_! Intercom and Paging Systems Each sign or outline lighting —_� $53.40 Signal circult(s)or a limited energy D Landscape Irrigation Control' panel,alteration or extension $75.00 Minor Labels(10) $125.00 _._ ❑ Medical Each additionol Inspection over the allowable In any of the above $62 50 ❑ Nurse Calls Per Inspection - -- Per hour $62.50 ❑ $73.7•`, Outdoor Landscape Lighting' In Plant Fees: Prolective Signaling Enter total of above fees $ _ Other 8%State Surcharge $ _ - _ _---Number of Systems 259E Plan Review Fee $ ' No licenses are required Licenses are required for all other installations See"Plan Review"section on fr,,nr nf-,pprcalion. -- --- Fees: Total Balance Due $ — Enter total of above fees $----- Trust Accountill___--_ 8%State Surcharge $ Total Balance Due $— All New Commercial Buildings require 2 sets of plans. i 41stsNbrmsklc-feer.de� 08/30101 Pht-inbiing permit Application -----�-- -- - Date received: Permit no.: city of Tigard Bard Sewer permit no.; Building permit no.: Address: 13125 SW Hail 131vd,Tigard,OR 97223 Project/appl.no.: Expiredate: City ufTigard Phone: (503) 639-4171 Fax: (503) 598-1960 Date issued: By: Receipt no.: Case file no.: Payment type: Land use approval: 7J Mulu-lamily U Tenant improvement ❑ 1 &2 family dwelling or accessory U Commercial/indusmal — U New consliuiaio ll Ailditiort/alteratiott/replacement U Food service LJ i)find tI IN J= t ' Fee ca. Total Descri tion ( ) LBIdg. address: rOb(,Y 1( .div � � U�t - New l-and 2-family dh'cllings only: no.: — (includes too ft.forea,chutilityconnection) map/tax lot/account no.: _ SFR(1)bath: ock: Subdivision: SFR(2)bathroject name: - SFR(3)bath City/county: ZIP: Each additional bath/kilchcn Site utliltles: Description and location of work on premises: ---- Catch basin/area drain �-Drvwells/leach linelUench drain Est.date of completion/inspection rooting drain(no.lin.ft.) _ M111jilKII'm Manufactured home utilities Business name: /4�c, `til,`✓ ll_n,N_1t3�: fZ Manholes Address: Rain drain connector State: ZIP: Sanitary sewer(no.lin.ft.) City: Storm sewer(no.lin.ft.) F'honc: q t y-�8 4 b �Fax: y -'] E-mail: Water service(no.lin.ft.) CCB no 0 Plumb.hos.reg.no: Fixture or Item: City/metro lic.no.: Absorption valve Contractor's representative signature: _ $ark now preventer Pent name: Date: Backwater valve (-ONTA(11'PERSON $asms/lavato CI) es washer Name: -- Dishwasher Address: - Drinking fountain(s) City: State: ZIF': E'ectors/sum Phone: Fax: E-mail: Expansion tank Pixture/sewer cap Floor drains/floor sinks/hub Name(pgnt): ------ rarba a dis Mailing address: Hose bibb City State: ZIP: _ Ice maker Phone: Fax: E-mail: Interco tor/ rease trap _. Owner installation/residential maintenance only: The actual installation Primer(s) -- will he made by me or the maintenance and repair made by my regular Ralf drain(commercial) employee on the property I own as per ORS Chapter 447. Sit k(s), asin(s), ays(s) Date: sun, Owner's signature: 'Pubs/shower/shower pan Uritial Name: Water closet Address: -Water heater — _ - -- - City: ]:state: ZIP: Other: Tnta Phone: Fnx: E-mail: _ Minimum fee................$ - Nd ell)uridlctions eccrlH ctm"cWw,I'lrere cell 111"w'ciion for nrxe informmion Notice:This;wrmit application Plan review(at a %) $ U Vi4a U mmiciCard expires if a permit is not obtained State surcharge(13%)....$ ----- Ordu cud nundwi __ __-___-- -_-_-_ _--L--1 within 1811 days after it has been ptpiree TOTAL .......................$ accepted as complete. Mune of cerdhokki a+hown on crrdii cmA s Cmdholder ei�rrmutr Arrarrnl 410-4616(61UtNt:OM) PLUMBING PERMIT FEES: PRICE T OT.AL New 1 and 2-family dwellings only: ^^� FIXTURES Individual QTY eat AMOUNT (includes all plumbing rixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatc - 16.60 for each utility+_connection) _ _ One 1 bath _ _-__ --_ $249.20_ 6 Tub or Tub/St Ner Comb r 16.60 Two 2 bath $350.00 Shower Only 16.60 Three(3)bath _ _ $399.00 1 _ Water Closet 16.60 _ SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%.OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16'60 PLEASE COMPLETE: 3" 16.60 4" _ - 16.60 - Water Heater O conversion O like kind 16.60 _ Quante b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. CaP�ed MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 l avato Tub or Tub/Shower Hose Sibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal _ -- Other Fixtures(Specify) 16.60 Dishwasher 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-1 a 100' 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures _ S ecl �._ Storm&Rain Drain-tet 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 - Commercial Back Flow Prevention Device 46.40 Residential Back"low Prevention Device 27.55 Catch basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspectionsper/hr COMMENTS REGARDING ABOVE: Rale Drain,single family dwelling 65.25 -- Grease Traps 1660 -- QUANTITY TOTAL Isometric or riser diagram Is required If Quan111y Total Is >9 _ _ *SUBTOTAL - --- 8%STATE SURCHARGE "PLAN REVIEW 25%.OF SUBTOTAL Required onil If flxhire qty to'ii Is>a TOTAL f *Minimum permit fee Is$72 50•a%state surcharge,except Residential Backflow Prevenlion Device,which is$SB 25-8%state surchaige "All New Commercial Buildings require 2 sets of plims with Isometric or riser diagram for plan review. I:\dsts,forrnsWlmdees.doc 08/29/01 Mechanical Permit Application Date re.eived: Permit no.: City O Tigard Projecdappl.no.: Expire date: - - - -- City ofTigard Address: 13125 SW Hall Blvd,'rigard,OR 97223 Phone: (503) 639-4171 Dale issued: By: Receipt no.: Fax: (503) 598-1960 C&icfile no.: Payment type: - Land use approval: BLilding permit no.: U 1 &2 fancily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New consincclion U Addition/altcration/replacenicnt U Other: 1 1IN X11jaaul , 1 - Job address: /61 (,,g y„ << u ' CUue�-T Indicate equipment quantities in boxes below. Indicate the dollar BIJg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax IoUaccount no.: profit.Value$ _ Lot: Block: Suhdi—vis iorr _ *Sec checklist for important application information and Project name: jurisdiction's fee schedule for residential permit Ice. City/county: ZIP: o r [inscription and location of work on premises: - r tI I IN 1W Iliac► WA , . t 1 1 t41((-JJ I oral Est.date of completion/inspection: Description tit . Re.s.onlr Res.onl Tenant improvement or change of use: A Is existing space heated or conditioned?U Yes U No Air handling unit —_CFM _ Is existingspace insulated?U Yes U No Air conditioning(site-plan require ) — p Alteration of existing VAC system _ Boiler/compressors Business name: i>s 6L F-05 C; CXjyt f TVZ4A r7K State hoiler permit no.: Address:�") J Sw/ ;/l I V(G - tit' ,_.Tons __BTU/H ,_ mo a amper, uctsmo a electors City: t; Statc: Of, ZIP:Phone: re pump f u nate qurner)— i - _ Y�1"$1. Fax:�t{�j_ E-mail: P CCB no.: 3 Including ductwork vent liner U Yes U No Insta rep ac re oca(c eaters-suspende . City/metro lie,no.; will,or floor mounted Name(please print): enc ora lance other than furnace t e etsIf Absorption units_ BTU/H Name: Chillers Address: Compressors Hl' t — -- .nr ronnrenta exhaust an rent at an: Y� Slater ZIP: --- Appliance vent Phone: I ,i I? mail )ryerex oust ooc s, 'ypr. /res. rte ten a�.mat hood fire suppression system Mhaust fan with sin le duct(bath fans) Mailing address: /n (p��W fit( C� �. �- Exhaust system aart rom teat n or — City' OltTL.�AVZ — StatacYl ZIP: ruel piping an o ul on(up to out ccs) Phone: Q0-'7030 jFaX E-mail: TYl1e - I.i'(i __ Nei _ Oil Fucl pipingeach addition over out els rocessp p ng(sc emal crequire ) Name: Number of outlets Address: Other listed app once or equ-pm - -- Ikcorative fireplace City: -- State: _ 7_IP: nsert (y -— Phone: _ I ux: L' mail — ou stove pe et stove Applicant's signature: Other: pp t �_-- gate: ter. Name ( rint): —-`Minimum ree................$ NM nil Jutlxllrllnna xxept rrdllt cards,plerur call lurlatlirucm Rx more intamnbn� Permit fel`... . ......... .... $ U visa U MasteWatd Notice:'Iltis permi(application Ordit card number. expires it's permit is not obtained - �(— within 130 days after it has been Plan review(at -`1•turte or c o res n on c u c - accepted as complete. State surcharge(11%)....$ _ $ TOTAL .......................$ t'ardhnlder alprature wmotm( – — 44tt-4617(~'OM) MECHANICAL PERMrr FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description --- -�- - Price Total $1.00 to$5,000.00_ Minimum fee$72.50 Table 1A Mechanical Code _ Qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional$100.00 or -including ducts&vents 14 00 fraction thereof,to and including 2) Fumace 100,000 BTU+ _ $10,000.00. Including ducts&vents 1 40 $10,001.00 to$25,000.00 $148.50 fvr the first$10,000.00 and 3) Floor Fumace - ---- $1.54 for mach additional$100.00 or including vent 1'.00 fraction th-9reof,to and Including 4) Suspended heater,wall heater $25,000.00. or floor mounted heater 14,U0 _ $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$100.100 or _ 6.00 fraction thereof,to and Including 6) Repair units $50000'00 12 15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: -Boller Heat Air $1.20 for each additional$100.00 or For Items 7.11 see or Pump Cond fraction thereof. footnotes below. Camp Minimum Permit Fail-72!FO SUBTOTAL; $ 7)<3HP;absorb unit _ to 100K BTU 14.00 8%State Surcharge $ 8)3-15 HP;absorb - - unit 100k to 500k BTU 25.8^ 250/r Plan Review Fee(o/subtotal) $ 9)15-30 HP;absorb - -- __Required for ALL commercial permits only unit.5.1 mil BTU 35.00 -- TOTAL COMMERCIAL PF.RMI 10)30-50 HP;absorb FEE: $ unit 1-1.75 mil BTU 52.20 -------- - ----- - - 11)>50HP;absorb _ unit>1,75 frill BTU 87.20 ASSUMED VALLIATIONS PER_APPLIANCE: 12)Air handling unit to 10,000 CFM OQSO-�Lo2_.___-_ _ _ Q Ea Value Total Amount 13)Air handling unit 10,000 CFM+ 10.00 Fumace to 100,000 BTI I including 955 17.20 ducts&vents 14)Non-portable evaporate cooler - Fumace>100,000 BTU including 1,170- _ 10.00 _ ducts&vents 15)Vent fan connected to a single dura Floor furnace Induding ventggg - 6.80 Suspended heater,wall heater or 955 16)Ventilation system not Included in _ floor mounted heater appliance permit 10.00 Vent not Included in applican(T445 17)Hood served by mechanical exhaust permit _ 10.00 Repair units �- -__ 805 18)Domestic Incinerators <3 hp;absorb.unit,JT 955 17.40 _ to 100k BTU 19)Commercial or Industrial type Incinerator 3-15 hp;absorb.unit, 5,700 -�- _8_9.95 101k to 500k BTU 20)Other units,Including wood stoves 15-30 hp;absorb.unit,501k to 1 10.00 mil.BTU 21)Gas piping one to four outlets 30-50 hp;absorb.unit, 3,4005.40 1-1.75 mil.BTU 22)More than 4-per outlet(each) >50 hp;absorb.unit, _ g 72g 1.00 >1.75 mil.BTU Minimum Permit Fee$72.50 SUBTOTAL: $ Air handlinkunit to 10,000 cfm 656 Air handlitig unit>10,000 cfm _ 1,170 8%State Surcharge $ Non-portable evaporate cooler - _ 858 liaTOTAL RESIDENTIAL PERMIT FEE: $� Vent fan connected to a single duct _ 448 Vent system not Included In 658 appnce Lermit -- - Hood served by mechanical exhaust ggg the n 0ectlons and Fees: LDomestic In anetator - _ 1,170 _� 1 Inspections outside of normal business hours(minimum charge-two hours) $72 50 per hour Commercial or Industrial Incinerator _ q 590 2 Inspections for which no fee is speclficaily Indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $72 50 per hour Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plena(minimum Gas piping 1-4 outlets 380 charge one-half hour)$72 50 per hour Each additional outial _ g3 'State Contractor Boller Certification required for units>200k BTU. TOTAL COMMERCIAL "Residential AIC requires sit•plan showing placement of unit. VALUATION: _ All Now Commercial Buildings require 2 sets of plans. I\dstslfomtsUnech-fees ac, 08129!01 Al�c— I 1 , •Q I i 13 m I 0 exlsT,��G 1 .80' 4+ause Is,00' 24° i� w lq° h4>~Ivv Ir-,B �. STORY ADDIS 011 I pl rc0� �"�-��T�F2 R�SIG�Ef��'°•�� 1 I �7o1:zY ApG�lt��t•a� �i 'aGA�.�: �•[)'Q�� ,�.,iii FROM KELSO ELECTRIC INC FAX NO. : 0000000000 Nov. 28 2:'31 03:32PM P1 y CITY OF TIGARD - (4j13125 S.W. HALL BLVD. 6 o TIGARD, OR 97223 XhA 66') C. IMPORTANT PERMIT NOTICE IMPC KELSO ELECTRIC INC 545 SE 3RD �Y ur'►1 0 , HILLSBORO, OR 97123 �,��3� Electrical Signature Form Prin-nit#: MST2001-00534 nate Issued: 11126/01 Parr,.-' 151341313-10400 Site Address. 10858 SW 118TH CT Suhriivision: PENN LAWN ESTATES NO.2 Block: I nt 032 .lurisdiction: TIG Zoninco, R-4.5 Remarks: Construction of 168 squwre foot addition. No Service Provider Letter required. `!our company has been indicated as the electrical contractor fort tic permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the ;t,-art of the work to tho address above,ATTN: Building Dept. No electrical inspections will be auttlorized until this completed form is recoived OWNER ELEG I HICAL CONI NACTOR: FOSTER, JAMES DIGALE A KELSO ELECTRIC INC 10858 SW 118TH CT 545 SE 3RD l�V Or" 97223 [41LL SBORO, OR 97123 I'I�c>111 tl Phone #: 503-648-6360 Reg #: a-ic 116254 SUP 4270s P-LL1 14.433c AN INK SI JNATURE IS REQUIRED ON THIS FORM Si �iure of Supervising Elsctrician If y�aa have any gLJOSU .ins, please call (503) 639-4171, ext, # 310 CITY OF TICARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business line: (503) 639-4171 BLIP _---_ 7 Received _.____ —Date Requested /� �' - AM_ PM -__ BLIP -� Location U b 4. ,��v _SuiteMMEC_ Contact Person _— Ph( —; �3 –Z-62 10 - PLM — Contractor Ph( __ I -_ SWR -- - BUILDING Tenant/Owner -- ELC - Footing _ ELC Foundation Access: ttg Drain ��'`1 J� C� EL-1 Crawl Drain - �— SIT Slab Insp ction Note Post&Beam Shear Anchors Ext Sheath/Shear -- -- - - Int Sheath/Shear Framing - - - - -- Insulation Drywall Nailing Firewall C Fire Sprinkler ------ Fire Alarm Suso'd Ceiling --- -- - - ---- -- - p4Ss.__pAE r FAIL 7- 1 LUMBING - Pos -- - ✓ �-�f-"` Under Slab WO 1C---- Rough-In Water Service - Sanitary Sewer Rain Drains —- --- Catch Basin/Manhole X1001 _ Storm Drain —`- Shower Pan P�kr�S -j- FAIL _ : IANICAL v—sL`- [_✓r ✓'.__r`lir-� ---- -- Rough-In ------ --- — ---- Gas Line Smoke Dampers ----- -- --- _. — 1"i FAIL -- --- -- --_— - RI _ Rough-In -- UG/Slab Low VoltageFife Alarm 0 Reinspection fee of$___- _ ___ required before next inspection. Pay at City Hall, 13125 3W Hall Blvd. ePAS$FyPART _ F] Please call for reinspection RE:_ _ __ [� Unable to inspect-no access Fire Supply Line - �, / o ADA Date -z Inspector r(/ Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL