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11640 SW FAIRVIEW LANE 0 1�. C-' �S 11640 SW Fairview Lane CITY OF TIGARD MASTER PERMIT T PERMIT 4: MST2002-00496 DEVELOPMENT SERVICES DATE IS';UEG: 1/13/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-41171 SITE ADDRESS: 11640 SW FAIRVIEW LN PARCEL: 2S103CD-05900 SUBDIVISION: TERRACE TRAILS ZONING: R-4.5 BLOCK: LOT: ill'/ JURISDICTION: IIG REMARKS: Addition of 82 sq.ft. BIP'.DING REISSUE: STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 92 st BASEMENT �0 LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sl GARAGE sl FRONT: PARKING SPACES! TYPE OF CONST: 5N DWELLING UNITS: I TWO at RIGHT: . OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: Bi st VALUE: '00 00 REAR PLUMBING SINKS: 1 WATER CLOSETS: WASHING MACH: 1 LAUNDkY rPAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUBISHOWERS: GARBAGE DISP: t WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: MECHANICAL OTHER FIXTURES: FULL TYPES FURN<10014: y01LICMP<3HP: VENT FANS: CLOTHES DRYER: FURN>00014: U 41T HEATERS: HOODS: ETHER UNITS: MAX INP: btu Fl OOR FURNANCE9: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENT IAL UNIT f ERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 •200 amp: 0 •200 amp: W,,;VC OR FOR: PUMPARRIGATION: PER INSPECTION: EA ADD•L 5009F: s0l 400 amp: 201 - 400 amp: 1 al WID SVC/FOR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 - w0;tmp: EAADDL BR CIR: 300 SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 001 1000 amp: 601+amps•1000v MINOR LABEL: 1000+amplvoll: PLAN REVIEW SECTION Reconnectnniv: »4 AES UNITS: 9VCIFDR»225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL P.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM, INTERCOM/PAGING: OUTDOOR LNOSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENT TION: MEL ICAL: OTHR; HVAC: DATARELE COMM: NURSr.CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL r`EES: $ 476.52 OSBORN,CYNTi IIA B AND DONALD L ANDREN CREATIONS This permit is suhlact to the regulations contained in the Tigard Mun Irip:,I Code,State of OR. Specialty Codes and 11640 SW FAIRV,EW LN GREGORY ANDREN all other apr,'.cable laws. All work will be done In TIGARD,OR 97223 19515 VIEW DR accordance with approved plans. This permit will expire If WEST LINN,OR 97068 work is not started within 180 days of Issuance,or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone: 503-699-1650 Oregon Utility Notifi,;atlon Center. Those rules are set forth In OAR 952-001-0010 through 952.001-0080. You Rea w: LIC 121 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Footing Insp Crawl Dlaln/Backwater Framing Insp Electrical Final Foundation Insp PLM/Underfloor Exterior Sheathing Ins► Mechanical Final Post/Beam Structural Mechanical Insp Gas Line Insp Plumb Final Post/Beam Mechanica plumb Top Out Rain drain Insp Building Final Underflnor insulation Electrllal Rough In Water Line Insp Issued By : ,�—'L �' �!_<� � �_ Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed the In t bu3lne, day Building Permit Application Lllty of Tigard r ['` Date received J'l..,� Permit no.: j Arlch'css: 13125 SW Hal i�t Fid; ProjocUappl.no.: Expire date: Cityq/Tignrd � V�, 1 hone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 n l Case fie no.: 21i�2 Payment type: Land use approval: _ ���' 1&2 family:Simple Complex: O CN 1 &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U New construction U Demolition Addition/alteration/replacement U Tenant improvement U Fire tiprinklerhdann U Other: :iINFORMATION Job address: //64 0 - r �/ Bldg.no.: Saite no.: Lot: P;oc:k: _ - - - 7 , Suhdivision: Tax map/tax lot/account no.: Project Hume: ---- _ Description and locatiop of wo 4on premises/special conditions: Name: . r ---- Moiling address: - I B 2 family dn'elling: City: State: ZIP: a Valuation of work........................................ $ Phone:rtf 9 6.10 yBS Fax: - E-mail: i No.of bedmomsfllaths..................... _ ............ Owner's ref resentative: Total number of floors tN f�-mail: .0j ............ New dwelling area(sq. ft.) ...7 .............Oarabe/carport area(sq. ft.)............ ......r �, ,v`�! �� Covered porch area(sq. ft.) .......... ...- address c— beck arca sy. ft.)�cl l5 ! __ (. .................... ................... a State• _ ZIP: c� DE,b' Other structure area 6� .ft.)......................... Phone: -�� .4, _ Fax:69`/-/4 5 t I t�:;:il --' CommerciaUlndustrieUmuitl-family: am Valuation of work........... .... ...................... $ Business name: Existing bldg. area(sc- ft.) .......................... Address: _ r S New bldg.arca(sq,it.) ................................ K K Stute�j ZIP: 70F,� Number of stories........................................ City: -t Phone:ra s 6'IH•/650 Fax:6ti y-/�s! E-mail � Type of construction.................................... CCB no.: I;L l -'1 — - Occupancy group(s): Existing: Pity/morn lie.no.: New: oil Notice:AM contractors and subcontractors are required to he t licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to he licensed in the Address:--� jurisdicti m where work is being performed. If the applicant is City: I State: 'LIP: exempt from licensing,the following reason arplics: Contact person: Plan no.: — - Phone: I F-mail -- -- X t111111111111111 Name. _ e onlacl person Fees due upon application ....... Address: Date received: City: [State: ,ZIP: Amount received ................... Phone: Fax:_ E:-mail: i _ Please r,:ter to fee schedule. — hereby certify I have read and examined this application and the Nrn dl Jurisdictions accept cr:dit cards.please cat)udsdictinn for m,ae udonnation attached checklist. All provisi s of laws a Ordinances governing this ovisa q Mastercar,i work will he complied with, ether spa i erein or not. Credit cud number Expire, Authorized signature: e: Z —NonK of cardholder a,@Fown on ciWit card Print name: _�r a� $ t}17 Cardholder d`nuure Amount Notice:This permit ap ication expire:;if pertpit is not obtained within 190 days after i!has been accepted as complete. 440 461.1 t6ma•oMt „ , t, �,,Q tv1 -1`� One-and Two-Family Dwelling Building Permit Application Checklist keIuenccno - -- Associated permits: City of Tigard City of Tigard U Electrical U Plumbing U!sty hanical Address: 13125 SW liall Blvd,Tigard,(tl 1)7:12 i c oilier Phone: (503) 639-4171 -- — — Fax: (503) 599-1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Ves No N/A I Land use actions completed.See jurisdiction crtcria lot concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designarnun,historic(1istrict.etc. 3 Verification orapproved plat/lot. 4 Fire district approval required. _ 5 Septic system penult or authorization for remodel. Exisling system capacity . 6 Sewer permit. 7 Water district approval. 9 Soils report.Must carry original at•;)licah)c Stamp and sif..nalure on file or with application. 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of ouch-basin protection,etc. 10 3 Complete sets of legible pians.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached to the plans with eros,,wiciences between plan location and details. Plan revicw cannot he completed if copyright violations exist. I I Sitelplot plan drawn to scale.The p Loa nimt sh(m i it mid huilding selhack dimensions;property corner clevatiom(it there is more than a 4-I11.elevation diltercnn;rl,I,Lu)runt ,how con(our lines at 24t.intervals);location of casements and driveway-,I'o olprinl of structure(111(1uditif d�•.).,r.L„ anon it +sill J.,rPtic systems;utility locations;direction indicauor;A- arrjj;4 ij di.t cyyLt9gr-atre-1�ercer rte;aar rr existing stntctures on site; _ 12 Foundation plan.Show dimensions,anchor Milts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show alp dimensions,roonn identification,window sire, location of smoke detectors,+vatcr heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 10 inches above grade,etc. 14 Cross seetlon(s)and details.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 he required to clearly portray construction.Show details til all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, themnal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimunn ol'two elevations I'or additions mill remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than foul foot at huilding env dope. Full-size sheet addendunns showing foundation elevations with cross references are acceptahle. _ ____F_ 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;fill non-prescriptive path analysis provide specifications and calculations to engineering suwdards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member si✓nig,spacing,and bearint, locations.Show attic ventilation, _ I9 Basement and retaining walls.Provide cuoss sections and details showing placement of rebar. For engineered systenns,see itern 22,"Engineer's+;d:ulauous." 19 Beam calculations.Provide two wl,,ul calculations using current Code desi)an vadueS lot.Al learns and multiple joists over 10 feet long and/or any beam/joist carrying a tion-unifornn load. _ -- _ 20 Manufactured floor/roof truss design details. _ 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gimpiping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided.(i.e.,shear wall,roc 1,miss)shall he stamped by an engineer or architect licensed in Oregon and shall be Shown to he applicable to th,• project under review. : Iota 23 rive(5)site plans are required for Item I I above-. Site.plans must be 9-1/2"x I V or I I'x 17". — 24 Two(2)wis each are required fur Items 16, 19,20& 22 above. 25 ©uildina plan%shall not contain red lines or tape-ons. "Mirrored"building plans will he not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit& System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 29 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and Car Street Tree List, Checklist must he completed before plan revic+v start date. Minor changes or notes on submitted plans may he in blue or black ink. Red ink is reserved for department use only. 4N4 a,aPA'Ohl) Mechanical Permit Application ' Date received: Permit no.: City of Tigard Project/appl.no.: Expire date: city ofngard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case rile no.: Payment type: Land use approval: Ifutwingpermitno.: t 1 &2 family dwelling or accessory U Commercial/industrial 'J Multi-family ❑Tenant improvement O New construction fSl Additiun/alteration/replace men I LJ Other: Job address: 0 s W 1�;L r n ,d w L v.. . Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: 'See checklist for important application information and Project name: jurisdiction's fi_-e schedule for residential permit fee. city/county: Description and h cation of work on premises:_ ) t ) s ) ev(Va.) total Est.date of completion/inspection: - tk-wription_ Qly. Res.onl) Res.onh Tenant improvement or change of use: _ s heated or conditioned?❑Yes U No Air conditioning unit CIM_ Is existing _ g•p ace it con non ng(s to plan re u re ) Is existing space insulated?U Yes ❑No A teration of existing H VAC system o er compressors Business name: /' t State boiler permit no.: (-n i HP Tans BTU/H Address:/6/ 1111 ' it sm-o c amper uctsmo a detectors City: Stat Z ZIP: t> eat-pump(s to ar.regF.treT Phone? t Fax: E-mail: Instal rep ace for.acefourne� Including ductwork/vent liner U Yes❑No _ _'ECL no.: Insto rep ace re locate heaters-suspended, City/Metro lic.no.: wall,or floor mounted Name( lease rint): vitt for n lance other than fuinacc Refrigeration: CONTACT PFR-14ON Absorption units_ BTU/H _ Name: Chillers— HP _ Address: — Com ressors_ HP :nv ronmenta 9haust end ventilation: City: LState: ZIP: Applioncevent _ Phone: I aK I mail: Dryerex oust t ,M, Hoods,Type res.kitcherdhazmnt hood fire suppression system - Name: Exhaust fan with single duct(bath fans) - -- - - Mailing address: Exhaust sstem apart from coon or C _ State: i i I Fuelpiping andistribution(up to outlets) City: _L Type: LPG _L_ NO Oil S4 f Phone: I-� it — E-mail �in vach additional over jut cls Process piping(schematic reou red) NurnW of outlets Name: Uther listed app anceort:qu pment: Address: Decorative fireplace City: Ttitatc: ZIP: Wood Phone: Fax: I nt,til stov pe et stove Ut er: Applicant's signature: I>atr: t er: Name(print): Nrn all Jurisdictions xcetN credrh verde.please eau jurisdiction rot more Information. Permit fee.....................$ N Visa U ons acMasterCord Notice:'I his permit application Minimum fee................$ _ 7 2 r 7O 1_ expires if a permit is not obtained Plan review(at _ %) $ _ Credit card numtR' within 180 days it has been Ir' - eepire9 y State surcharge(8%)....$ 30 Nene of vardholder a shown on credit cad accepted as complete. Cardholder signature Amoum 410-4617(6401170M) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: DesQlptlon: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A A_echanical Code Qty (Es) Amt $5,001.00 to$10,000,00 $72.50 for the first$5,000.00 and 1) Furnace.,)100,000 BTU $1.52 for each additional$100.00 or including ducts&vents 14.00 fraction thereof,to and Including 2) Furnace 101,000 BTU+ $10,000.00. Including ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$16,000.00 and 3) Floor Furnace $1.54 for each additional$100,00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.80 fraction thereof,to and including 6) Repair units $50 000.00. 12.15 $50,001.00 and LIP $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 Compor Pump Gond fraction thereof. footnotes below. Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to 100K BTU 14.00 _ 8%State Surcharge $ 8)3-15 HP;absorb unit 100k to 500k BTU 25.60 -- 9)15-30 HP;absorb 25%Plan Review Fee(of subtotal) $ unit.5.1 mil BTU 35.00 ial p Rnulred for ALL commercermits only _ - TOTAL COMMERCIAL PERMIT FEE: $ 10)30absorb unit 1-11.7.7 5 mil BTU 52.20 11)>5011P;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: Qt Ea Amount _ 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct ducts&vents _ 6.80 _ Floor furnace Including vent 955 16)Ventilation system not Included in Suspended heater,wall healer or 955 appliance permit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not Included in appliance 445 10.00 permit __..... 18tiIncinerators Repair units 805 )Domestic Incneraors 17.40 <3 hp;absorb.unit, 955 _ - 19 to 100k BTU )Commercial or industrial type Incinerator 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU 1000 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mll.BTU 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil,BTU 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mll.BTU Air handling unit to 10,000 cfm 656 _ 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not included In 656 appliance permit Hood served b 1 mechanical exhaust 656 4ihty Inspections and Fees: Domestic Incinerator 1 170 $02 So per outside of normal business hours(minimum charge-two hours) $62 50 hour Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $62 50 per hour Inserts etc. 3 Additional plan review required by changes,additions or revisions to pians(minimum Gab piping 1-4 Outlets _ 360 charge-one-half hour)$62.50 per hour Each additional outlet 63 - 'State Contractor Boller Certlflc,ri^n required for units 1,200k BTU. TOTAL COMMERCIAL $ "Resldentisl A/C requires site plan showing placement of unit. VALUATION:_ All New Commercial Building!a require 2 sets of plans. I:\dsts\fcrms\mech•fses.doc 02/11/02 '^c11!rar Building Fixtures Plumbing Permit Application City of Tigard Date received: _ Pri���ii no.: % Sewer permit no Building permit no.: - - City of Tigard Address: 13125 SW Nall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Projecdappl. no _ Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: _i Case file no.: Payment type: 113 11 N ,k1 &2 family dwelling or accessory U Commercial/industrial U Multi-family O Tenant improvement U New construction r,Addition/alteration/replacement O Food service O Other: Job address: 116 N 0 5.W. llescription Qty.I Fee(ea.) Total Bldg. no.: I Suite no.: New I-and 2-family dwellings only: (includes 100 ft.for each utility connection) Tax map/tax lot/account n-- SFR(!)bath _ Lot: Block: Subdivision: SFR(2)bath Project name: b n r SFR(3)bath City/county: o ZIP: 7,2 3, Each additional bath/kitchen Description and I ation of work on premises: Siteutilities: _ Patch basin/area drain Est,date ol'completion/inspection: Drywells/leach line/trench drain Footing drain(no.lin. n.) _ _ - Manufactured home utilities Business name: 1 t Y. --- Manholes Address: ,,Woz IS 0 t _-.1 _ Rain drain connector City: i I State ZIP: 7 ci I Sanitary sewer(no. lin. n.) _ Phonc: Fax: E•mail: Storm sewer(no.lin. it.) CCB no.: Z Ll � � Water service no. lin, n. . . City/metro lic.no.: / - q, �yd 3 Fixture or item: Contractor's representative signature Absorption valve Back (low preventer Print name: Date: Backwater valve -- - � e Basins/avatory _ Name: Clothes washer 07 -Address: Address: Dishwasher Q -- - -- ----- Drinking fountain(s) City: State: ZIP: -------�---- Ejectors/sump Phone: I Fax: E-mail Expansion tank Fixture/sewer ca Name(print): Floor drains/floor sinks/hub Mailing address: Oat bage iis oral / -- -- Hos.bib City: State: Z[P: Ice maker Phone: Fax: I E-mail: Interceptor/grease trap Owner instal Iation/res idential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof rain commercial employee on the property I own as per ORS Chapter 447. Sink(s),basin(s), ays(s) / brJ ire Owner's si nature: Date: Sump Tu s/sower/shower an Name: 'Jrin�— Address: - - - -- later closet Water eater City: State _ ZIP: other: Phone. I E-mail: Total , Not all jurisdictions accept credit cards,please call jurisdiction for more Information. Minimum fee................ $ �ti i S� Notice: This permit application U Visa U MasterCard Plan review(at o— �) $ _ �n expires if a permit is not obtained Credit card number. / / State surcharge(8%).... $ S, So apira � within Igo days after i1 has been Name of codholdet ass own on credit-card accepted as complete. TOTAL........................ $ 3n A -3_� Cordhol er signature Amount 440-4616(NWi(Y)MI PLUMBING PERMIT FEES: - PRICE TOTAL kN 7-and 2•fsmily dwellings onty. PRICE TOTAL QTY ea AMOUNT s all plumbing fixtures in AMOUNT FIXTURES (indiviuuai) _ 16.60 lling and the first100 ft. QTY (ea) Sink _ _ h utility connection) $249.20 Lavatory 18'80 bath 16.60 Lbath $350.x10 Tub or Tub/Shower Comb. 3)bath_________ $999.00 Shower only -- 16.60 Water Closet 16.60 SUBTOTAL 18.60 8°/.STATE SURCHARGEUrinal REVIEW 2.5°!.OF SUBTOTALDishwasher 16'60 _ TOTAL -.._16.60 -- Garbage Disposal - 16.60 Laundry Tray Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.600 6.6PLEASE COMPLETE: Y 18.600 4" 16.60 -- Quantic b Work Performed 16.60 Fixture Type: Now Moved Replaced Remo a Water Healer O conversion O like kind Ca ed Gas piping requires a separate mechanical permit. 46.40 Sink MFG Home New Wstar Service Lavator MFG Hosie New San/Storm Sewer 46.40 Tub or TublShower 16.60 Combination Hoed Bibs 18.80 Shower ON rtoof Drains Water Closet Drinking Fo nu�ta nlnl R'80 Urinal Other Fixtures(Specify) Dishwasher) Garbs a Disposal Laun d Room Tra Washin Machine Floor Drain Sink: 2" 55.00 9" Sewer-let 100' 46.40 4" Sewer-each additional 100' Water Heater Water Service-1el 100' 55.00 Other Fixtures Water Service-each additional 200' 46.40 S ed Storm C Rain Drain-1 sl 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 _ 46.40 Commercial Back Flow Prevention bravice _ Residential Backflow Prevention Devine' 27.55 16.60 Catch Basin _ Inspection of Existing Plumbing or Speciall8or/h COMMENTS REGARDING ABOVE: y 2.50 Re uested Ins actions 65.25 - - Rein Drain,single family dwelling 16.60 - Grease Traps _ QUANTITY TOTAL __------- -" Isometric or riser diagram is required if t7uanllty total le >9__ ---- •SUBTOTAL -8%STATE SURCHARGE -� ------ "PLAN REVIEW25%OF SUBTOTAL Required only If fixture qty total la>g _ OTAL s "Minimum permit fee in$72 50+8 stale surcharge,except Residential Backflow Prevention Device,which is$36 25+a%stale surcharge, "All New commercial Buildings require 2 sets of plans wi+ti Isometric or rifer diagram for plan review. I:\dsts\forms\plm-fees.doc 12/26/01 Electrical Permit Applicattion Datereceived: Permit no.: City Of Tigard 11roject/appl.no.: Expire date Clly,fTlgard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 G-n - Fax: (503) 598-1960 -�+��� 1r Caw rile no.: Payment type: �, J Land use approval; ' pnta 1 &2 family dwelling or access-,ty U .ti/utdu9rrtnl U Multi-family U Tenant improvement U New construction 1�1 �tj>;1Tilnitcr,tu ntirrl,l,u ran nl U Other: U Partial .100 SITE INFORMATION Job address: 4l p (,v. �r-�c+y„ ALV,, i Bldg, no.: Suite no.: ITax map/tax lot/account no.: Lot: Block: Sohl vision: _ Project name: Os{orn. Description and location of work on premises: ^ Estimated date of completion/inspection: . 1 Job no: fee Max Business(tame: 1rsKcr(than Q11• (ea.) li,Utl nn.ht� NewresidentW-stngk•ormulwfantih lw•r Address: S V) dwelling unit.Inclu,"attached garage. Cit tate ZIP; Service Included: Phone: Fax: I E-mail: I(xx)sq It.or less _ 4 finch additional 500 sq.A.or portion thereof CCB no.: r7 Elec.bus.tic.no; oto _ _ Limited energy,residelalAl 2 City/metro lie.no.: - r — 3 Limited energy,non-residential 2 Hach manufactured home or modular lwelling Signature of supervising electrician(required) Date Service and/or feeder 2 Sup.elect.name(print): License nn Servicesorfemders—Installation, PROPERTV alteration or relocation: OWNER 200 amps or less 2 Name(print): 201 amps to 400 amps 2 Mailing address: 401 amps to 600 Amps _ 2 601 amps to 1000 amps 2 City: Slate- ZIP: Over 1000 amps or vnl!s 2 Phone: 77Fax, I E-mail: Reconneoonl I Owner installation:The installation is being made on property I own Temporarywrvicesorfeeders - which is not intended for sale,lease,rent,or exchange according to installation,altersiIon.orrelocation: ORS 447,455,479,670,701, 200 amps or less 2 201 amps to 400 amps 2 Owner's si nature: Dale; 401 to 600 amps Branch circuits-new,alteration, or extension per panel: Name. A. Fee for hronch circuits with purchase of Address: _ service or feeder fee,each branch circuit _ City: Slate: I I P B. Fee for branch circuits without purchase '— of service or feeder fee,first branch circuit: / 4!, p�' 2 Phone: Fnx: Il rn,nl Each additional hranci:circuii: bc.(Service or feedor not Included): U Service over 225 an;ps-commercial U Health-care facility Each pump or Irrigodoo circle 2 U Service over 32O amps rating of 1 Ret U Hazardous location Each sign or outline lighting 2 family dwellings U Building over 10,(XKk,j, tett four or Signal circuit(s)or a limited energy panel. U System over 60()volts nominal more residential units in- •structure alteration,or extension* 2 U Building over three stoles U Feeders,400 amps or store *Description: U(kcupant load over 99 persons U Manufactured suvcturrs or R V pnrfc F'ich additional Inspection over the ailowablo:in any of the above: U EgressHightingplan U Other _ -- Perins ction F_T--T--,T-- Submit ` T --"T--Submit rets of plans with anv of the drove. Investigation fec _ the above are not applicable to temporary construction service. Other Not all)udsdlcdons accept credit cards,please call)uri-Abe ion for mote InrnrmYsan. Nutice:This permit application Permit fee.....................$ U Visa Ll Mastercard expires if a permit is not obtained Plan review(rd , %) $ _ JOE Credo cord number within 180 days after it has been State surcharge(8%) ....$ ?_ _ Name of c— erg e3—r u r own on credit card ' re' accepted as complete. TOTAL ... Z, r _ S _ cardholder signature Amount 4404615(NOCOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED Kk7SIDENTIAL ONLY Complete Fee Schedule Below: -- -- --- P Restricted Energy Foe..... ........... $7a.00 Number of inspections per permit allowed p p (FOR ALL SYSTEMS) Service included: Items Cost Total T , Check Type of Work Involved: Residential-per unit 1000 sq.ft.or less $14t� 1 4 ❑ Audio and Stereo Systems' Each additional 500 sq.ft.or portion thereof _ $:13.40 1 ❑ Burglar Alarm I.imited Energy $75.00 ^ _ Each Manufd Home or Modular Dwelling Service or Feeder _ $90.90 2 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems 401 amps to 600 amps _ $160.50 2 601 amps to 1000 amps $240.60 2 ❑ Other Over 1000 arnps or volts $454.65 2 Reconnect only $66.85 _ 2 Tempornry Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL. ONLY Installation,alteration,or reloca!lon Fee for each system...................................................... $75 00 200 amps or less $66.85 _ (SEE OAR 518-260-260) 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 r❑ Now,alteration or extension per panel LL Boller Controls a)Tire fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit _ $6.65 ' ❑ Data Telecommunication Installation b)The fee for branch circuits without purchase of sarvtce Fire Alarm Installation or feeder fee. First branch circuit $46.65 _ Fech additional branch circuit $6.65 ❑ HVAC Miscellaneous instrumentation (Service o feeder not Included) Each pump or Irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal clrcult(s)or a 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 �_^_ $62.50 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 :y No licenses are required Licenses are required for all other installations front of application. _ -- -- Fees: Total Balance Due $ —�— Enter total of above fees : ❑ 1rusl Account q_ __ 8%State Surcharge $ Total Balance Due : All New Commercial Buildings require 2 sets of plans. iAdsts\forms\elo-fas.doc 09/30/01 L1VE- 5TpEE'T Ty 1 A CATiAOE 14 d1wSL i � I f � \ 0° o` �► cn Zr — 0 0 ?a i� v, 3 cr.°o �c oaID w N ° W cCT ,�; '4 3 O CD N 00 o v - ate Cr q � � � -0 0 W m ... , . 0 115 �,• N . K x Y CITY OF TIGARD 24-Hour �1 BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 SUP Received __—-_.-_-- Date Requested `' a-___- AM____ _PM—.____—_ BUP Location j L(0 /t.1t`' � �-_..Suite-- MEC — __-- Contact Person — __ °h (--__—) 340 Z 4SS-71 PLM SWR -------- —--- ILDIN Tenant/Owner __ _— _— _-- ELC ELC Foundation Access: T• h Ftg Drain / �� �cvocv i Q w �►�.._ ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam _ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing ration call Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PAS RT FAIL ------ ----- --- - -- -- -- - ---___—.._. Under Slab ------------- — -- - - -- — —_..__ Rough-In Water Service ----- ------- - Sanitary Sewer Rain Drains --------- - 1— — - --- - --- - - -- -- Catch Basin/Manhole Storm Drain - -- ---+ —_ — ------- - Shower Pan ` PART FAIL _ --' -- -------__—..---------_ --_.. ---- --S_NICA_L - ------ -- Post& Beam Rough-In -- - --- - - -- - --- Gas Line Smoke Dampers ----- --------- --___.__-- -_—_—.- Final PASS PART FAIL - ELECTRICAL '_^_ Service —— -------- ------ -- __-__ Rough-In ----- --- --- -- -- — Ur/Slab Low Voltage --- ---- - -------- ---- —-- ---- Fire Alarm aSS PART FAIL Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. -- F] Plsase call for reinspection FIE: Unable to inspect- no access Fire Supply Line ADA2 Approach/Sidewalk Date a l� /f� InaPuctor ?1�� _ Ext Other: Final DO NOT REMOVE this Inspe tion record from the Job site. PASS. PART FAIL