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13621 SW MOUNTAIN RIDGE COURT-1 pno:D 9CP!',d ulLjunoW MS 4Z9£6 0 u d m a C c ILix o' U) N r m coo 5 M w r .J 13621 ^W MOUNTAIN RIDGE CT CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2003-00719 13125 SW Hall Blvd., Tigard,OR 97223 (503)e39-4171 DATE ISSUED: 12/17/03 PARCEL: 2S 109BA-00700 SITE ADDRESS: 13621 SW MOUNTAIN RIDGE CT SUBDI#/ISION: THREE MOUNTAINS ESTATES ZONING: R-7 BLOCK: LOT:015 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VEN t FANS: OCCUPANCY GRP: R3 VENTS WO APPL: VENT SYSTEMS: STORIES: BOILERSiCOMPRESSORS _ HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCtN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30.50 HP: WOODSTOVES: GAS PRESSURE: 50* HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: OTHER UNITS: 1 FURN >=100K BTU: <= 10000 cfm: > GAS OUTLETS: 10000 cfm: Remarks: In,tallation of gas insert in. sting fireplace. Gas piping is already installed as a gas assist to existing fireplace. Owner: FEES JOAN HENSEY Description Date Amount 13621 SW MOUNTAIN RIDGE CT IMECII)Permit Fee 12/17/03 � $72.50 TIGARD, OR 97223 [TAX] R"/"State Surchart 12/17/03 $6.80 Phone: 503-590-2536 Total $78^30 Contractor: STARDUCT INC 3 MONROE PARKWAY STE P427 LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS Phone: 503-254-1300 Mechanical Insp Final Inspection Reg#: LIC 156009 IL oc J_ m W This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes J and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if worts is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires pp_to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 ' r_ 1Is ed By: Permittee Signature: -rlj Call(503f639-4175 by 7:00 P.M.for Inspections needed the next business day ,k11 hanical Permit Application Rrceived Mechanical DatdB : / /7 !.J Permit No- Ciity of Tigard Planning, Building e Date/By _ Permit No.: 13125 SW Hall Blvd. Plan RL"'w Other Tigard,Oregon 97223 Date/By: _ Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review LAnrl Use 'j . Datc/B : _ Case No Interriet www.ci.tigat;!.or.us Ccntact furl See Pogo 2for 24-how-Inspection Request: 503-639-4175 Narne/Mcthod: Su l amental Information. TYPE OF WORK ~ COM 1FRCIAI.FBE• UL8-USE CHECYJAST New construction_ _ Demolition Mechanical ..,nit fees*are based on the total value of the«ork Addition/alteration/replacement Other: performed. Indicate,tt,e value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,ovet head and profit. 1 do 2-Family dwelling Commercial/Industrial value: S____ _ See PaP�1 for Fee Schedule Arcessoy Building Multi-Family _ RE'�'�`�EQUIIPMENT/SYYS_TF;.tS.Fl6B�SCNLrUUI'E Mister Builder _ Other: Deacrl tlon t Qty Fe ea. __ Total _ Heada Cooling JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning"• _ 14.00 Job site address: S(o,2 t �„`,/ c" ,A _ j C Gas heat pump 14.00 Suite #_ Bldg./Apt.#: Duct wsrk 14.00 Project Name: _ r S _k,�j H dronic hot water system 14.00 Residential boiler Cross street/Directions to joWsite: for radiator or h dronic system) 14.00 Unit heaters(fuel,not electric) in wall,in-duct,suspended etc. 14.00 Flue/vent for any of above 10.00 Subdivision: Lot M Repair units 122 15 Other Fuel A ltancea _ Tax map/pa rcel#: water heater10.00 DESCRIPTION OF WORK Gas fireplace 1 V,' �_ 10.00 1 /o. c� S ct( /✓LJ o/` til P l s h Flue vent(water heater/gas fireplace) - 10.o0 I _ Lo lighter asL_ 10.00 -- Wood/Pellet stove _ 10.00 Wood fireplace/insert 10.00 _ _ Chimney/liner/flue/vent 10.00 PROPERTYOWNER . TENANT Other: 10.00m Name: ► t^ J ( Itrvirorental Ezkoust&VertUathm Address: l 3 0.21 t ,,y�e�,�.�,,, �, I Range hood/other kitchen equipment _ 10.00 City/State/Zip: 7't 9°� On q -?.a 1-Y Clothes dryer exhaust 10.00 - -- Single duct exhaust Phone:2.5-g9O—,9�5-3?o I Fax: _ (bathrooms,toilet compartments, APPLICANTI LICONTACT PIL IMN utility rooms) 6.80 Name: Attic/crawl space fans 10.00 Address: Other: 10.00 Fad MMus a Clt /State/Zip: _ **($5.40 for first 4,51.00 each addidonal Phone: Fax: Furnace etc. I. — Gas heat pump _ •• tq E-mail: Wall/suspended/unit heater •• ��-- CONTRACTOR Water heater t,I Business Name: ar►t Fite lace •• Co Address: XRange •• 'ur BB •• W City/State/Zip: — Clothes dryer as •• —t Phone: 1°3 3.9-(- t Fax: Other: *• CCB Lic. #: S fo(TV __ Total: Authorized Mechanical Permit Fees* Signature: �� Date:��r _ �� _ _ Subtotal: S Minimum Permit Fee 572.50 S '—►�,c� Plan Review Fee(25%of Permit Fee) S (Please print name) State Surcharge(R%of Permit Fc 5 ,3. 70 TOTAL PERMIT FEE $ Notice: This permit application expires If a permit Is not obtained within *Fee methodology set by Tri-County Building Industry Service Board. 180 days after It has been accepted at complete. "Site plan required for exterior A/C units. i\Dsts\Permit Forms\MecPerrtitApp.doc 01103 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: _ TOTAL VALUATION: PERMIT FEE: $1.00 to$22,OW.07' Minimum fee$72.50 $2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30 for each additional$100.00 or fraction thereof,to and ,including$5,000.00. $5,001.00 to$10,000.00 41.50 for the first$f,000.00 and SLBO for each additional$100.00 or fraction thereof, _ and i luding$10,003.00. S 10.,001.00 to 550,00).00 $231.5 or the first 510,000.00 and 5 for each addit nal$100.00 or fracti thereof,to and includin S50,000.t)0. i 550,901.00 to$100,000.00 $771.50 for th first$50 0.00 and S 1.25 for each additional 0 or fraction thereof,to _ and including$1 000.00. $100,001.00 and up $1,396.50 for a fi t$100,000.000 and $I.�0 for h additi al$100.00 or fraction thereof. All New Commercial Bui Ings require 2 sets of plan . a H t� W 1 1BuildingTermit FormsWecPermitApoPg2 09-01-03.doc CITY OF TIGARD A--{t v, 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMP')RTANT PERMIT NOTICE WEST SIDE ELECTRIC CO INC 1834 SE STH AVE PORTLAND, OR 97214 VED Electrical Signature Form Or, ,s 1ooz Permit#: MST2002-00335 Lt f 1, UN Date Issued: 812/02 $��rDN , Parcel: 2S109BA-00700 �N Site Address: 13621 SW MOUNTAIN RIDGE CT Subdivision: THREE MOUNTAINS ESTATES Block: Lot: 015 Jurisdiction: TIG Zoning- R-7 Remarks: Closet addition to bedroom/bath remodel.Path 1 Your company has been indicated as the electrical contractor for tho 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 frorn your company sign below and return this Electrical Signature Form prior to the start of the work to the address above,ATTN: Bulldprg Dep.. No electrical inspections will be authcrized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: GILLASPIE WEST SIDE ELECTRIC CO INC 13621 SW MOUNTAIN RIDGE 1834 SE STH AVE TIGARD, OR 97224 PORTLAND, OR 97214 Phone #: 503-246-5050 'hone#: 231-1548 Reg #: SUP i ssas ELE 2GA35c i r n ►- AN INK SIGNATURE IS REQUIRED ON THIS FORM t X SigM& of Supervi n ectrician �.. .n a c � l!..'f►1�E� r�iv If you have any questions, please call (503)639-4171, ext. # 310 i 'd LL90-9EL r 09) '03 o Z Jzoa T 3 app;g zsaM v2* t Lo Zo so gnu �■itsat CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 NT PERMIT NOTICE ► Y IMPORTANT ; STANDARD PLUMBING + HEATING �`, ` `�; ►►�st��l Z1 PO BOX 19205 ` PORTLAND, OR 97280 � Plumbing Signature Form Permit #: MST2002-nO335 Date Issued: 812/02 Parcel: 2S109BA-00700 Site Address: 13621 SW MOUNTAIN RIDGE CT Subdivision: THREE MOUNTAINS ESTATES Block: Lot: 015 Jurisdiction: TIG Zoning: R-7 Remarks: Closet addition to bedroom/bath remodel-Path 1 Your company`ias been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permii to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of tho work to the address above, ATTN: Building Dept. No plumbing Inspections will sae authorized until this completed form Is received OWNER: PLUMBING CONTRACTOR: GILLASPIE STANDARD PLUMBING + HEATING 13621 SW MOUNTAIN RIDGE PO BOX 19205 TIGARD, OR 97224 PORTLAND, OR 97280 Phone #: 503-246-5050 Phone #: 246-3338 a Reg #: I IC 00007309 PI M 26-72PB AN INK SIGNATURE IS REQUIRED ON THIS FORM m W Aggnature—o4fAuthorized --_ PlUmber If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 244Iour � � • BUILDING Inspection I.Ine: (503)639.4175 ® - INSPECTION DIVISION Business Line: (503)6394171 MST BUP Received __ -___ __Date Requested - AM PM __ BUP -- _ Location lt_ hl7"-rz,�5�_ - Suite .3- Contact Person _ Ph( —) -- -_ PLM Contractor - _ Ph SWR _ BUILDING _ Tenant/Owner -_ ELC - Footing -_ ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspaction Notes: SIT -------- -- Post&Beam Shear Anchors -- Ext Sheath/Shear ___----- Int Sheath/Shear Framing Insulntion Drywall Nailing -- --- - -- Firewall Fire Sprinkler ---- ------ -- ---- -- ---- - --- Fire Alarm Susp'd Ceiling -- --- -- -- - --. --___ Roof Other: -- _-- -._-- - Final ---------- PATS PART FAILPLUMBING Post Post&Beam Under Slab - -- Rough-In Water Service - - ----- ---- -_- Sanitary Sewer Rain Drains - -- - - - ---- Catch Basin/Manhole Storm Drain - -- --�- - - `- Shower Pen Other: - Final .--------- PA FAIL Post& Seam --- Rough-In Gas Line d S pars N r ART FAIL -- -_ -- --__-__-__®_ ELECTRICAL Service -_--- -- ----- m Rough-In ---_- UG/Slab WL,)w Voltage - ---__ _____-_- -_- -_--- --._._---- -- --- Fire Alarm Final lPART FAIL El Reinspection fee of$ -__-required before next inspection. Pay at City Hali, 13125 SW Hall Blvd. PASSWE ❑ Please call for reinspection FIE:_-_- _ _-. - Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dat�l _ �` _�� _.- Issipoatotr Other: _ Final - 00 NOT REMOVE this Inspstdon remrd Ilam thw job she. PASS PART FAIL f MASTER PERMIT _ CITY O F T I G A R D PERMIT 0: MST2002-00335 DEVELOPMENT SERVICES DATE ISSUED: 8/2/02 13125 SIN Hall Blvd.,Tigard, OR 97223 (503)639-4171 SITE ADDRESS: 13621 SW MOUNTAIN RIDGE CT PARCEL: 2S109BA-00700 SUBDIVISION: THREE MOUNTAINS ESTATES ZONING: R-7 BLOCK: LOT:015 JURISDICTION: TIG REMARKS: Clo, Idition to bedroom/bath remodei.Path 1 BUILDING REISSUE: �t✓ STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALW 1 HEIGHT: FIRST: of BASEMENT: 11200 of LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: of FRONT: PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: of RIGHT: VALUE. f 5,M0 00 OCCUPANCY GRP: R3 DORM: 1 BATH: 1 TOTAL: 0.00 of REAR: PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH. LAUNDRY TRAYS: RAIN DRAIN: TRAPS- LAVATORIES: 1 DISHWASHEPS: FLOOR ORAIHS' SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUR/SHOWERS: 1 GARBAGE DISP: WATER HEATFRS: WATER LINES: RCKFLW PREVNTR: GREAIE TRAPS: OTHER FIXTURES. MECHANICAL ___ FUEL TYPES FURN c 100K: SOIUCMP c 3HP VENT FANS: 1 CLOTHES DRYER: FURN>000K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR rURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER _TEMP SRVCIFEEDERS BRANCH CIRCUITS _MIS�� d1.18 ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp. 0 200 amp: WISVC OR FDR: PUMPiIRRIGATION: PER INSPECTION: EA ADO'L 500SF: 201 - 400 amp: 201 " 400 amp: 1st WIO SVCIFDR: SICINIOUT LIN LT: PER HOUR* LIMITED ENERGY: 401 600 amp: 401 "600 amp, EA ADOL BR CIA: SIGNALIPANEL: IN PLANT: MANU HWSVCIFDR: 601 - 1000 amp: 601+ampe•1000v: MINOR LABEL- 1000. ABEL1000.SMON01t _ PLAN REVIEW SEC TION Reconnect only: >.4 RES UNITS: SVCfr-DR>-226 A.: >600 V NOMINAL: CLS AREAISPC OCC- ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNOSC LT: MURG'.AR ALARM: OTH: MOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL A SYSTEMS: Owner: Contractor: TOTAL FEES: $ 343.46 This permit Is subject to the regulations contained in the GILLASPIE CLIMAX CONST CO "Tigard Municipal Code,State of OR. Specialty Codes and 13621 SW MOUNTAIN RIDGE BOX 19751 all other applicable laws. All work will be done In TIGARD,OR 97224 PORTLAND,OR 97280 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 nlles are set Reg 0: 'IC 16616 forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to i OUNC by calling(.503)246-1987. I REQUIRED INSPECTIONS I Footing Insp Electrical Service Plumb Final Post/Beam Structural Electrical Rough In Final Inspection Underfloor insulation Framing Insp PLM/Underfloor Insulation Insp Plumb Top Out Electrical Final r � /, �:L `,� Permittee SI natL�ra Issued By .. �, �� !�d�L 1 _ 9 _ Call (503)639-4175 by 7:00 p.m.for an Inspection needod the next b siness day- Building Permit Application w PT& I l& p A Perm?t no.:�"r�ycity o z,ig>I, Project/appl.no.: Expire date: City qf Tigard Address: 13125 SW[All$lvd,Tlg&W,(* RIA9 batt issued: Recei ftno.:Phone: (503) 639-4171 / Fax: (503) 598-1960 li L Case file no.: Payment type: 1&2 family:Simple Complex: Land use approval:U1 Y U l iA JAftr I;11 rir T"— "&2dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition Y K rY U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: c. INE 101 to)tal WIN I On � . Job address: ) Bldg.no.: Suite no.: t Lot: Block: Subdivision:3p(} � Tax map/tax IoUaccount no.: Project name: d Description and location of work on premises/special conditions:_ ' - - ,_ Name: Mailing address: 2 1 &2 family dwelling: City: 776.4 .Stat.: ZIP: Valuation of work........................................ $ 0 VAN Phone: 0Fax: E-mail: No.of bedrooms,'baths................................. Owner's representative: Total number of floors..............]]rr Phone: — Fax: E-mail: New dwelling area(sq.ft.) ..�1.......... _�_ Garage/carport area(sq.ft.)........r................ Name: Covered porch area(sq.ft.) .........................I. Mailing address: "r Deck area(sq.ft.) ........................................ City: State 7.IP: Other structure arca(sq. ft.)......................... . ,one k, ;IX. E-mail Commeirc[*Ulnde,trid/multi-family: RifValuation of work........................................ ArI]ANI Wall-�X �h existing bldg.arra(sq.ft.) .......................... .business name-�'�j� " New bldg.area ft................................... J (sq ) Address: Number of stories. City: Stale ZIP: Type of construction.................................... Phone: W- Fax: E-mail: Occupancy group(s): Existing: CCB no.: Nev. _ City/metro lic.no.: Notice:All contractors and subcontractors are required to be NJ U 111611111 licensed with the Oregon Construction C3ntractors Board under Name: provisions of ORS 701 and may be required to be licensed in the IL Address: jurisdiction where work is being performed.If the applicant is ILState: ZIP: exempt from licensing,the following reason applies: City: U) [Contact Plan no.: person: — --�-- - -_ Phone: Fax: E-mail:mm — J_ m Name: Contact person: Fees due upon application ........................... S W Date received: _ Address: -- -J City: — State: 71P: Amount received ......................................... $ Phone: E-mail: Please refer to fee schedule. 1 hereby certify I hav read an ex in application and the Not all Ju► .cep credk tarda.&W call jKlsdiction far mac irrfortoetlan. attached checklist.A provisi is la s a ordinances governing this 0 Visa U MasterCard work will be complied het r ci d herein or not. Credar card nrrmbr, —___�_.___� __�L_. Expires Authorized sl re. Date: _ Name of cwdbo der as shown nn credh card—� _ f _ Print name: — Amos Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted dq complete. 4404617(6WXW one-and Two-Family.Dwelling Building Permit Applieatimi Checklist Referenceno.: Assoc Wed permits City of Tigard City of Tiand U Electrical O Plumbing LJMechanical Address: 13125 9� Hall Blvd,Tigard,OR 97223 a Other: Phone: (503) 63 4171 Fax: (503) 598-1460 1 1 VOR'PLAN REY111,11 1'e% No NIA I Land use actions completed.ScejAw7on criteria for concurrent reviews. 2 Zoning.Flood plain,rolar cc points,seismic soils designation,historic district,etc. 3 Verification of approv plat/lot. 4 V4re district Z approval required. 5 Septk system rmit ora thorization for remodel.Existing system capacity 6 Sewer t. 7 WaterAstrlc roval. > 8 Sot r_port. Mustbarry oriinal applicable stamp and signature on file or with application. P oslon control ❑plan Q rmit required. Include drainage-way protection,silt fence design and location of Catch-basin roteclion,etc. C 10 3 Complete sets of legibli plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design�tetails and connections must be incorporated into the plans or on a separate full-size jleeiatt�ched to the plans will rocs references between plan location and details. Plan review cannot be completed if copyright violations exist. p 11 Sitelplot plain drawn to scale.Nplari must show lot and building setback dimensions;property c e ations(it' there is more than a 4-ft.elevation 'ffcrential. I ntour li s ; ation of ea and ti av�y;lix+t}a♦i+�lwt me ing ec s);location o . . .ystems;uti a c ton indica or,lot arca;huilding coverdge area;percent` a 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 size and location. 13 Floor plans.Show all dimensions,roo identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixt s,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all fra ing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More one ct6ss section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,11-p-1 slope.ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new coet' lions tion;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral an sis plans.Must indicate detaili and locations;for non•prescriptive patIt analysis provide speci tcat'ons anit.calculations to engineering standards. 17 Floor/roof framing.Provide plans for alltorsrroof asse blies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provid6cross sections and det ' s showing placement of rebar.For engineered systems,see item 22,"Engineer's cale ations." 19 Beam calculations.Provide two sets f calculations using current c design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss d9Agn details. N. 21 Energy Code compliance.Idem' y the preset iptive path or provide calculati A gas-piping schematic is required for four or more appliances. '_ 22 Engineer's calculations.Whe required or provided,(i.e.,shear wall,roof truss)sha stamped by an engineer or architect licensed in Oregon d shall be shown to;re applicable to the project under revie 23 Five(5)site plans are mqui d for Item I 1 above. Site pians must be 8-1/2"x 1 I"or 11"x 17". 24 Two(2)sets each arc requi d for Items 16, 19,20&22 above. 25 Building plans shall not c tain red lines or tape-ons. "Mirrored"building plans wall be not accepted. 26 "Reversed"building plans must meet criteria outlined in rile Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applir•ahle),and COT Street Tree List. 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. 440-4614(&%KYN) 4AElectrical Permit Application Date received: Permit no. (Sf w) 'a r 4, City Of 'Tigard Project/appl.no.: Expire date: City o!�I•i1,,nrd Address: 13125 SW Hall Blvd,Tigard,OR 97221 Dale issued: By: Receipt no.: Phone: (503) 639-4171 ----— Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alleration/rcplaceinent U Other: U Partial Joh address: . Bldg.no.:_ Suite no.: Tax map/ax Iot/account no.: Lot: i Black_: .'ubdivision: C5_7217-CS -- Project name: z_ Description and location of work on premises: Estimated date of com letion/ins etion: — Job no: Fee Max Business name: Description .(ea) Tetal no.im —H New rexld"flat-single or annhi-f■may per Address: TK dwelling unN.Includes alaclred pprage. City: Slele�I� ZIP Sericeincluded: Phone: Fax: E-mail: 1000 sq.ft.or less 4 CCB no.: I Elec.bus.lie.no: �i Each additional 500 sq.ft.or portion thereof Limited energy,residential 2 City/metro lic.no.: Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature of supervising electrician(required) Date Service and/or feeder 2 Sup.elect.name(print): License no: :5onlces or feeders—Installation, alteration or relocation: 200 amps or less 2 Name(print): �^ 201 amps to 400 amps 2 -- — 401 amps to 600 amps _ 2 Mailing address: _1 601 amps to 1000 amps 2 City: State' ZIP: Over I(100 amps or volts 2 Phone: Fax: -trail. Reamnectonl 1 Owner installation:The installat. n is being made on property I own Temporary services orfeeden- which is not intended for sale,lease,rent,or exchange according to I"stallntlon,alteraflon,orreMntlon: ORS 447.455,479,670,701. 200 amps or less — 2 201 amps to 400 amps 2 Owner's si nature: Date: 401 to 600 ams 2 Rrarich circuits-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase dPhone: fax: E-mail:— of service or feeder fee,first branch circuit: 2 Each additional branch circuit: I— Mise.(.Service or feeder not Included): yy� 7rhmilylings amps commereiel ❑Health-cam facility Each pump or irrigation circle 2 amps-rating of 1 k2 U Hazardous location Each sign or outline lighting 2 U'wilding over 10,00(1 square feet,our or Signal circuit(s)or a limited energy panel, m ysemovervolts nomina! more residertial units in one atm•ture alteration,or extension* — 2 U Building over three stories U Feeders,400 amps or more •Deurition: _ LL! U Occupant load over 99 persons U Manufactured structures or R V park Each addillonal Inspection ever the allowable in any of the abovas J U Egress/lightingplan U Other: ---- erinspection Submit_+ets of plans with any of the above. I Investigation fee _ 'Me above are not applicable to temporary cotntracflon service. r6iher Not all jurisdictions accept credit cards,please call jurisdiction for more informatiem. Notice:7111s permit application Permit fee.... ................$ _ U visn U MasterCard expires if a permit is not obtained Plan review(at __ %) $ C'mfit card number: within 180 days after it has been State surcharge(8%)....$ Expires accepted as complete. TOTAL .......................$ Nerve of c u ahorrn eat t card '.-- s cardboider a are Amount 4404615(6MCOW ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT. FEES: - TYPE OF WORK INVOLVED-RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee......................................................,_ 175.00 Numbor of Inspect''' is r rmit allowed (FOR ALL SYSTEMS) Service Included: Items CO Total Check Typo of Work involved: Residential-pet unit 1000 sq ft.or less $14 15 4 ❑ Audio and Stereo Systems' Each additional 500 sq It or portion thereof $3 40 1 ❑ Burgiar Alarm imited Energy $7 .00 Each Manufd Home or Modular Dwelling Service or Feeder $ .90 2 ❑ Garage Door Opener" Services or Feeders F-1 Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $ .30_ 2 ❑ 201 amps to 400 amps $10 .65 2 Vacuum Systems* 401 amps to 600 amps $16 .60 _ 2 601 amps to 1000 amps $24 60 _ 2 Over 1000 amps or volts _ $41- 65 2 Reconnect only _ $6 5 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66. 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.3 2 401 amps to 600 amps $133.7 _ 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits ❑ New,alteration or extension per panel Boiler Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Instrtiatlon b)The fee for branch circuits without purchase of service ❑ or feeder fee.or Alarm Installation First branch circuit I_ $46.65 ❑ Each additional branch circuit $6.651 HVAC Miscellaneous ❑ Instrumentpdr,n (Service or feeder not included) Each pump or Irrigation circle _ $53.40 ❑ Each sign or outline lighting $53.40 Intercom and Paging Systems Signal circuit(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 T Outdoor Landscape Lighting* Fees: Protective Signp ling Enter total of above fees $ , ❑ they 8%Stato Surcharge $ _ -,..------Number of Systems 25%Plan Review Fee See"Plan Review"section on $ ' No licenses aro ulred Licenses are required for all other installations front of application. Total Balance Due $ Fees: -"� Enter total of t+fu:q fees EJTrust Account ilf __ 8%State Surcharge i Tctal Balance Due All New Commercial Buildings require 2 sets of plans. i:\dsts\fnmtsklc-fees.doc 08/30/01 Plumbing Permit Application pDatermeived: Permit no.:(,1 rJr a1�7�(n� City Of Tigard Sewer permit no.: Building permit no.: Acftlress. 13125 SW I tall Blvd,Tigard,OR 97223 :'i(vuJTi�nr`1 Plior_ (503) 639-4171 Project/appl.no.: Expiredate: F;,x: (503) 598-1960 Date issued: By:�- I Receipt no.: Land :IS(- approval: � Case file no.: Payment type: ,Igrl& 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant impro wnenl U New construction U Addition/al(cration/replacement U Food service i_I Other. _ Job address: _rn =tel • Dewription Qt . !?re ta.) Tota! Bldg.no.: Suite no. New 1-and 2-family dwellings only: Tax map/tax lot/account no.: (Includes 100It.for each atllityconnection) SFR(1)bath Lot: Block: Subdivision: SFR(2)bath _-- Project name: SFR(3)bath _ City/county: , ZIP: Each additional hath/kitchen Qr,scriplion and location of work on ises: , 2J _ sheadilllea: 800-t-- Catch basin/area drain Est.date of completion/inspection: Drywells/Ieach line/trench drain soassainvii Footing drain(no.lin.ft.) Manufactured home utilities Business name: �, • Manholes Address: Rain drain connector City: State ZIP: Sanitary sewer(no.lin.ft.) Phone: Fax: E-mail: Storm sewer(no.lin.ft.) CCB no.: Plumb,bus.reg.no: (� Water service no. in.ft. City/metro tic.no.: I-cl o, Aor New: Absorption ion valve Contractor's representative signature _O - B -- ack flow revenler Print name: I Date: Backwater valve sumBasins/lavatory Name: Clothes washer Address: Dishwasher City: State: zip., Drinkin fountain(s) Ejectors/sum Phonc: Fax: E-mail: Expansion tank _ Jim I Fixture/sewer cap Name(print): Floor drains/floor sinks/hub Mailing address: 3� ( Illy . Garbage disposal Hose bibb CitState ZIP: Ice maker LL Phone: Fax: E-mail: Interceptor/grease trap Owner ms allatian/resi ential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ J Owner's signature: Date: Sump m Tubs/shower/shower pan (,9 Name: Urinal Water closet W Address_ _ Water heater City: State: ~ ZIP: _ Other: Phone: I E-mail: Total Not all jurisdiction&accept credit cards,plei+e call jurisdiction for more inftmnatiort. Minimum fec................ Notice:This permit application O Vi9hsa U MasterCard expires if a permit is not obtained plan review(al _ ) $ Credit card number: —L—/ — within 190 days after it has been State surcharge(8%)...•$ F.apircr Name of cardholder as row drown on credit card accepted as complete. TOTAL .......................$ _ S cmilbolder dptatore Amount 41p4616(6OOICOM) PLUMBING PERMIT FEES., PRICE TOTAL New i and 2-family dwellings only: FIXTURES individual) QTY sa AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sank 16.60 the dwelling and the fiist100 ft. QTY Wal AMOUNT ---r-- for each utility connertlo_n1 Lavatory 10.60 One 1 bath _ $249:'.0 Tub or rub/Shower Co . - 1660 Two(2)bath $350.01 Shower Ony t 1P 50 Three(3)bath $399.00 _ Water Closet 16 a0 SUBTOTAL _ Urinal1 -�- 16.60 8%STATE SURCHARGE Dishwasher 1660 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal t 16.60 - _TOTAL_________._]_ laundryray 16.60 Washing Machine 16.50 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 18.60 Water Heater O converse n O like kind 16.60 Quanti h Work Performed Gas piping requires a separ�te mechanical Fixture Type: New Moved Replaced Remov.+► I ermit. __ Capped MFG Home New Water Sery46.40 Sink MFG Home New San/Storm war 46.40 Lavalo Tub or Tub/Shower Hose Bibs te.60 Combination _ Roof Drains 16.60 _ Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 - Urinal _ _ Dishwasher Garbage Dispo Laundry Room Tray -- Washing Machine _ Floor Drain/Sink: 2" _ Sewer-1st 100' 55.00 3" - G' Sewer-each additional 100' 4640 v - ,4" - Water Service-1st 100' 55.00 Water Heater Water Servicp-each additional 200' 46.40 Other Fixtures Storm&Rain Drain-1st 100' 55.00 _ Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 -- Residential Backflow Prevention Device' -,2755 - -- Catch Basin 1k.60 Inspection of Existing Plumbing or Specially 62. Requested Inspections _ erth COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.2 - _- Grease Traps J 16.60 s - - QUANTITY TOTAL Isometric or riser diagram Is required If QuantityTotal is >9 -- "SUBTOTAL 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL Required only If fixture qty.total is>9 TOTAL E •fdinlmum permit fee Is$72.50+B%state surchatge,except Residential Backflow Prevention Device,which Is$36.25+6%statslLrcharge, "All Near Commercial Buildings require 2 sets of plans with Isome!ric or riser diagram for plan review. I:%dsts\formsXplm-fees.doc 12/26/01 I CITY OFTIGA RD _~ y ;24-Hour BUILDING Inspection Line: (503)6394175 M _ 0 INSPECTION DIVISION Business Line: (503)639.4171 • BUP Received _—�P i)ate Rened 2 �Z!AM PM BLIP location __ _— � _ Q _Suite_ MEC Contact Person _ � J f�G�' 1'�- �g�) D�- 45,E�o PLM `--` Cont r Ph(— ) SWR TenanVOwner _ ELC Foundation Access: ELC Fig Drain Crawl Drain ELR Slab Inspection Notes: 7 SIT Post&Beam - Shear Anchors _ Ext Sheath/Shear Int Sheath/Shear -- Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm --- Susp'd Ceiling Roof PART FAIL Poat eam Under Slab Rough-In - - --- Water Service Sanitary Sewer Rain Drains _ Catch Basin!Manhole Storm Drain — Shower Pan f`in I -- AS PART FAIL _ANICAL Post&Beam — iL Rough-In a Gas swine l.. Smoke Dampera Final - PASS PART FAIL J €L e'1 ICAI� F _ Service _ Rough-In a UG/Slab ------ L("N Voltage Reinspe tlon fee of$_-_____ required before next Ina t PART FAIL pectlon. Pay at City Nan, X31^5 SW fled 13hni. SITEPlcese call for reins Fire Supply Line U peatlon RFS_.--_-._ _ _ U Unable to inspect-no aca.+ss ADA �) Approach/Sidewalk / `�' 1 Other: Final DO my woo"lhle 1"Pt di"reowd hgnii 60 fob silly. PASS PART MAIL .EXIlkrr4 lAk • * 7 A Wue- .2xry I6'4CW— t" 14-- L Ti�r��rCna o. \ �\ � f6� -C--- . �R-21 iutw. i.Dr)/u>Qv. AAral..c0>7ereTe. ... CAS K)L A am LIABIL TY The City of Ti rd and its employees s II not he responsible for screpancies which may app ar herein. N • - RLUILIVED - JUL 15 2002 m (.11rUf' !W AU Wc7 carr of no�so f// B[1TLn>N(}B r ....... '7 Fo.-h 500500MM worw � F ERMIT Np/�,.�.�v� .'c... .1 lOfll/kr FNbw..-.-. .... Job AddrM. By __. 7— S L: 1 �A 5�1 - lw g _ 44 ---�� 1lo Ft�r.-10 J V✓ I I Ft - Irl _ ew_LLP r 6 tp " �h w��.t. is arw•�i��'4d a•�.c t .4•-41 IA7 W r CLCJ�SP�`/��jl� ,4�• r.��, di C�kw-s-- n ENO iso- M_`i�'p f' r a - 'a LD a w J 'iHY f�IL w � w r • r l� r �.1 l� c II � C► Y �Wsw MEN EWEN mmm ONE �� oinin millill "IBM �■r �� 1011111 SIA rIA 1 3 �� a M a� c�