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9235 SW MILLEN DRIVE-1 en!J(] uall!W MS 9£Z6 m LO 0 c a i 3 _ N N _m Q1 W ,.J 9235 SW MILLEN DR CITY OF TIGA11D 24-Hour BUILDING Inspection Line: (503)639-4175 ST 7 INSPECTION DIVISION Business Line: (503)639-4171VUP Reccived ____ Date Raquested_Z,L ?1—,Z__.AM_ PM _ SUP __l-ocation __�L 5 1�,L 1 114 04 i.)Z __ Quite_ MSEC Contact Person _ —__. __ Ph(_ ) —_____ __— PLM Contractor _ _ -- Ph(______) SWR UILDIN ' _ Tenant/Owner _ —_ __�— ELC Footm � "` Foundation _-- Ftg Drain ELR AOC93S. Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing — Insulati in Drywall Nailing _— Firewall Firs Sprinkler — - Fire Alarm Susp'd Ceiling — -- Roof Other: -- ASS PART FAIL Under Slab _ Rough-In Water Service --- ---- — Sanitary Sewer Rain Drains — — - -- ---- - Catch Basin/Manhole Storm Drain ---------- Shower Pan - Other: --- -- — -- — --—_ A FAIL P , earn Rough-In Gas Line a Smoke Dampers � F PAfq FAIL --- -- J Rouilh-In Ito LIGA"lat Low Voltage _j Fire A;..z,m Fina! Reinspection fee of$_ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _ n Please call for reinspection RE:—____.___...____- _ Q unable to inspect-no access Fire Supply Line 'v�.�'�► ADA � _ p Approach/Sidewalk AaAb-- .�_ ��'� sctos---------- ------EXE -- Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPOR'(ANT PERMIT NOTICE UNIVERSAL PLUMBING (DAVID RAY OAKLEY) 8811 SW SPRUCE STREET TIGARD, OR 97223 Plumbing Signature Form Permit #: MST2002-00374 Date Issued: 10/2/02 Parc rfl: 2S114AB-02400 Site Address: 09235 SW MILLEN DR Subdivision: Block: Lot: Jurisdiction: Zoning: Remarks: 770 sq.ft. addition above garage Your company has been indicated as the plumbing contractor for the permit indicatEd above. In order for the plumbing permit ' ) be valid, please have the appropriate individual from your company sign below and return this Nlumbinq Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing i,ispections will be authorized -n0, this completed form Is received OWNER: PLUMBING CONTRACTOR: CHIP & BRENDA AYERS UNIVERSAL PLUMBING 9235 SW MILLEN DR (DAVID RAY OAKLEY) TIGARD, OR 97224 8811 SW SPRUCE STREET TIGARD, OR 97223 Phone #: 503-598-0774 Phone #: 452-7480 Reg #: MET 00004191 a LIC 111472 PLM 26-589PB AN INK SIGNATURE IS REQUIRED O HIS FORM X Signature of Authorized Plumb If you have any questions, please call (503) 639-4171, ext. # 310 TdpWu I us. h VIS ��� �� �'���� MASTER PERMIT PERMIT#: MST2002 00374 DEVELOPMENT SERVICES DATE ISSUED: 1012102 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 99235 SW MILLEN DR PARCEL: 2;. 114AB-02400 SUBDIVISION: TONING: BLOCK: LOT: JURISDICTION: REMARKS: 770 sq.ft. addition above garage BUILDING REISSUE: STORIES: FLOOR AREAS _ REQUIRED SETBACKS _ REQUIRED r_ CLASS OF WORK: ADD HEIGHT: FIRST: eI BASEMENT: of LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 41 BECORO: 170 at GARAGE: of FRONT: PARKING SPACES! 2 TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: a/ RIGHT: VALUE: 00,00000 OCCUPANCY GRP: R3 DORM: 11 BATH: TOTAL: 770 ofREAR: _ PLUMBING SINKS: WATER CLOSETS: I WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: Sr RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS-. 1 WATER LINES: BCKFLW PREVNTR: UREASE TRAPS: OTHER FIXTURES. MECHANICAL FUEL TYPES FURN<100K: 1 BOILICMP,3HP: VENT FANS: 2 ` ! CLOTHES URYER: 1 GAS FURN>-IOOK: UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FORNANCEO: VENTS: 1 WOODSTOVF.S: GAS OUTLETS: i ELECTRICAL _ RESIDENTIAL UNIT _SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS__ ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 amp: 0 200 amp: W/SVC OR FOR: 1 PUMPORRIGATION: PER INSPECTION: EA ADD'L SOOSF: 201 -400 amp: 201 -400 amp: 1a1 W/O RVC/FDR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 600 amp- EA ADDL BR CIR: SIGNAL/PANFL• IN PLANT: MANU HMISVCtFOR: 601 • 1000 amp: 600ampe•1000v. MINOR I-ABEL: 1000♦ampivolt PLAN REVIEW SECTION Reconnect only: >-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA/SPf'OCC: ELECTRICAL•RESTRiCTED ENERGY _A.SF RESIDENTIAL � _ 0.COMMERCIAL _ AUDIO S,STEREO: VACUUM SYSTEM- AUDIO A STEREO: FIRE ALARA: INTERCOMIPAGING: OUTDOOR LNOSC ,: BURGLAR ALARM: OTH: BOILER: .1VAC: LANDSCAPEIIRRIG: PROTECTIVE SIONL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS' Contractor: TOTAL FEES: $ 1,622.60 Owner: Fhis permit is subject to the regulal'ons contained In the CHIP R BRENDA AYERS PETERSEN CONSTRUCTION INC Tigard 14wnicipal Code,State of OR. Specialty Codes 9235 SW MILLEN DR PO BOX 2226 and all other applicable laws. AN work will be done in TIGARD,OR 97224 WILSONVILLE,OR 97070 accordonoe with approved pians. This permit will expire If work Is cot started within 180 days of issuance,or if the work is susp*.nded for more than 180 days. 4. ATTENTION` Oregon law requires you to follow rules Phone: 503-598-07?4 Phone: 503-312-0043 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAP.952-001-0010 through Rag 0: LIC 96688 952-001-0080. YOU may obtain copies of these rules or d -1 REQUIRED INSPECTIONS f'J Footing Insp Electrical Rough:n Insulation Insp Final Inspection W PLM/Underfloor Framing Insp Rain drain Insp Mechanical Insp Low Voltage Electrical Fina; l Plumb Top Out Gas Line Insp Mechanical Final i Electrical Service Gas Fireplace F1lumb Final 1 Issued By: , � IA IZZA,&_ d�� Permittee Sign tire ^all(503)639-4175 by 7:00 p.m.for an Inspection neede a next business day BuJV.iqJg Permit Application QtCt1VGd Building M��< Date/By: g l 1 Permit NOS –Dr7 3 City or Tigard Planning Approval Other S Test Form Date/© : Permit No.: 13125 SW Hall Blvd. Plan Review �_- Other �t Tigard,Oregon 97223 Date/By: �- -� 0 Z S r Permit No.: Post-Review land Use e Phone: 503-6394171 Fax: 503-598-1960 Date/By: Case No. I:i`ernct: www.ci.tigard.or.us Contact Juris.: Ll Sec Page 2 for 24-hoer Inspection Request: 502-639-4175 Name/Method: _ Supplemental Information flA —� TYPE OF WORK � REQUIRED DATA: New construction I El Demolition 1 &2 FAMILY DWELLING Addition/alteration/re lacement Other: CATEGORY OF_CONSTRUCCION _ Note: Permit fees*are based on the total Valce of tht work performed. Indicate 1 &2-Family dwelling Commercial/industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. + AccessoryBuilding__ Multi-Famil LJ Master Builder Other: Valuation......r4f=0............................ S __ d f berooms: _ JOB SITE INFORMATION and LOCATI N No.o L No.of baths: - --- t Job site address: 2 Total number of floors.....................................New dwelling area(sq.R.).............................. Suite#: Bld ./A t.#: Garagetcarport area(sq.ft.)............................ _ Project Name: Covered porch area(sq.ft.)............................. t C�rosJ�street/Directions�tojob site: Deck area(sq.ft.)............................................ 1 k41�^aI Other structure area(sq. ft.)............................ REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: Lot#: --- --- ------ --- -- - ---- — Tax ma I arccl#: Note: Permit fees'are based on the total value of the work per mred. Indicate DESCRIPTION OF WORK the valde(rounded t t nearest dollar)of all equipment, rials,labor, _ overhead and profit f the work indicated on this applic n. Valuation.......................... ....................... ... S_ --- Existing building area(sq.ftT,..... ........... New building area(sq.fl.)......... ........... Number of stories................ ......................... ROPERTY OWNER -TENANT Type of construction...... .............................. _ Name: �.:. T— 4� C Occupancy group(s): Existing: New: Address 012 Cit /State/ZI C-1, Phone: . 1 Fax: NOTICE.: All contractors and subcontractors are required to be APPCONT CT PERSON licensed with the Oregon Construction Contractors Board under LICANT provisions of ORS 701 and may be required to be licensed in the BUstness Natne: V_ jurisdiction where work is being performed. If the applicant is exempt Contact Name: 1AA from licensing,the following reason applies: a address: 114 —V - oc Cit /State/Zi : 1 Phone Fax: BUILDING PERMIT FEES* ^-- E-mail: Please refer to fee schedule. CDDLTRACTOR -- ----------- - - ---- M Business Name: Fees due upon application............. ................ S_ W Address: 'J Cit /State/Zi Amount received............................................. S Phone: I D;,te received:__,- CCB L' - - Notice: This permit application expires If o permit Is not obtained within Autho zed 1110 days atter It has been accepted as complete. Si '�-��.�'Date: *Fee r,ethodology set by Tri-County Building Industry Service Board. 3 (Please print name) 1_0 -3-7 P One-and Two-Family Dwelling Building Permit Application Checklist Rrferanceno.: Acm,ciatedpermits: Cio-ofhgard City of Tigard ❑1s:^ctrical U I'lumhinF U Mech:viical Address: 13125 SW I fall f;lvd,'I igard,OR 97223 U Othrr: Phone: (503) 639-4171 -- Fax: (503) 598-1960 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 7777t/ 2 Zoning.hood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. 4 Fire district approval required. _ 5 Septic syiem permit or authorization for remodel.Existing system capacity i 6 Sewer permit. 7 Water district approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance t)applicable local and state building codes.Lateral design details and connections must be incorporated into the plans or on a separate full-size V sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer c,evations(if there is more than a 4-Il.elevation differential,plan must show contour lines at 2-R.intervals);location of easements and driveway;footprint of stricture(including decks);location of wells/septic systems;utility locations;direction indicator,lot area;building coverage arra;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-crowns and reinforcing pads,connection details,vent ✓ size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.Mcre than one cross section may be required to clearly portray construction.Show y/ details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace constriction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation_elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indican details and locations,for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating;member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rehar.For engineered systems,see item 22,"Engineer's calculations." _ 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple.joists ✓ CL _ over 10 feet long and/or any beam/joist carrying a non-uniform load. 2i` Manufactured floor/roof truss design details. N21 Energy Code compliance. Identify the prescriptive path or provide calculations.A gas-piping schematic is required U) for four or more appliances. 2: Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or J architect licensed in Oregon and shall be shown to be applicable to the project under review. m W23 five(5)site plans are required for Item I I above. Site plans must be 8-1/2"y t I"or I I" x 17". "J 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be 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. 28 Site plan to include tree size,type&location per approved project street tt�plan(if applicable),and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink. Red ink is reserved for department use onl. 440-4614(ter WOM) Mechanical Permit ADDlication ReCCived Mechanical Date/By: _ Permit NoA 5 rd,'7V'A D D 371_ T .»-; r Planning Approval Building t City of Tigard Dste/I, : Permit No.: 13125 SW Hall Bivd. er Plan Review w Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-6394171 Fax: 503-59FAfti00t'l PaDate/1l�c/By:iew Land Use _ Case No.: Internet: www.ci.figard.or.us 1 Contact Juris.: See Page 1 for 24-hour Inspection Request: 503t-r�66"WN r=r, Name/Method: Supplemental Information. 1�7 Vi++15 V L ---� MN TYPE OF WORK COMMERCIAL FEE'SCHEDULE-USE CHECKLIST New construction _I El Demolition Mechanical permit fees'are based on the total value of the work Additiot�/alteration/re lacement Other: performed. Indicate the value(rounded to the nearest dollar)of all CAT';GORY OF cement I F1 CONSTRUCTION mechanical ma•crials,equipmer ,bor,overhead and profit. & 2-Family dwellin Commercial/Industrial Value: DEpli1 for Fee Schedule Accessory Building_ Multi-17amily _ RESIDE NTIAI,F.QUIPMENTISYSTEMSFFE•SCIik:DULE Descrl rUon t Fee ea. Total J Master Builder —Other: licelln)t%Cooling! _ JOB SITE INFORMATION and LOCATION Furnace-add-on air conditionir� 14.00 WOZ Job site address:y {' t, Gas heat pump 14.00 Suite#: I31dg./Apt.#: Duct work 14.00 Project Name: g H dronic hot waters stem 14.00 - Residentia,boiler Cross street/Direct ons to job site: for radiator or hydronic system) 14.00 I��T`QV— 71 CIA{ZAZ) 4 . Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc.) 14.10 Flue/vent for any of above 10.0) Subdivision: i Lot#: Repair units 12.15 �_-- Other FuelA rllancn _ Tax map/parcel #: Water heater I OAO T'20 o_ DESC PTIO OF WORK Gas fireplace IG.W 01 Flue vent water heater/ as fireplace) _ 10.00 �� �� / � Log lighter (gas) 10.00 _ — Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimne /hy 'ner/flue/vent _ 10.00 PROPERTYOW E TENANT' �`" fir" '`' '' Other: 10.00 � Name: ' Environmental Exhaust&Ventilation J � Range hood/other kitchen equipment 10.00 10.E Address: Clothes dryer exhaust 10.00 ,� Cit /State/Zi l(AJ_t �j� - Single duct exhaust Phone: -D` Fax: (bathrooms,toilet rompartrnents, APP T CONTACT PERSON_ utilityrooms 6.80 �s.�} Name: Attic/crawl space fans _ 10.00 Other: _ _ 10.00 _ Address: �` Fuel Plpint: CL City/State/Zip: 1(.. ��Q�, Q $5.40 for •• neat 4 $1.001 ch additional Furnace etc. «` a Phone: 1 J Fax: Gas heat purnp •• _ F- E-mail: Wall/suspended/unit heater I '• N __C NTRACTOR Water heater «° ?- __ _ .• F� Business T:dme: �„I�s t A Fireplace _ mAddress: c,J -clBB a .. City/State/Zip: 9-7Z Clothes dryer�as :• -J Ph)ne: r) Fax LC Other:L. CCB Lic. #: Total: Mechanical Permit Fen" _ Subtotal: $ ZZZO_ Authorized Minimum Permit Fee$72.50 S _ Signature: Date: Z El _ Plan Review Fee 25%of Permit Fee S IV State Surcharge(8`/•of Permit Fee) S _ TOTAL PERMIT FEE S (Please print n e) Notice: Th11 permit application etplres If a permit Is not obtained within Igo days aver it has been accepted as complete. "Fee methodology set by Trl-County Building Industry Service Board. Plumbing Permit AD_plieation Received Plumbing / Date/By: Permit No.:/W-::,T affj. Planning Approval Sewer City of Tigard Test Form Date/B_ Permit No: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Post-Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 D-te/ y: Land Use — _ ■te/B Case No.: Internet: www,ci.tigard.or.us Contact Juris: See P■ge 2 f�r 24-hour Inspection Request: 503-639-4175 Name/Method: Su niemental Ldorm■tion. I V PE OF WORK FEE`SCHEDULE forspecial Informati-n'use checklist 1`Iew construction Demolition Description I Qty- F'ee(ea.) I Total Addition/alteration/replacement -]Other: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION (Inch,des 100 R.for each utilityco rection) _ SFR(I)bath �_y 249.20 KI & 2-Family iwel;in C'tammercial/.`ndustrial r SFR 2 bath 350.00 cesso Bt:{ldii� Multi-Famil SFR 3 bath 399-00 Master Builder Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler-sq.ft.: Pa c 2 Job site address: % lL� Site Utilities _ Suite#: Bldg./Apt•#; Catch basin/area drain 16.6_0 Pro'ect Name: ��-�;,. _ D welUleach line/trench drain 16.60 Fooling drain no.linear R. Page 2 Cross Strect/Directions to job site: Manufactured home utilities 110.00 _ w'E`Jr OF Manholes _ 16.60 _ Rai i drain connector 16.60 Sam:ary sewer(no.linear R.)— Pa c 2 ` Subdivision: J Lot#: Storm sewer(no.linear R.) _Pa c 2 -- Water service no.linear R. Pa e 2 Tax ma / arecl#: Fixture or Item _ DESCRIPTION OF WORK Abso tion valve 16.60 Backflow prcvcnter Pae 2 Backwater valve 16.60 Clothes washer _ 16.60 --- — —� Dishwasher 16.60 i Drinking fountain 16.60 ROPE TY O TENANT Ejcctors/su_m-- 16.60 ame: . A Expansion tank 16.60 _ 7Z Fixture/sewer cap 16.60 Address: Q�5� � t _ -- Cit /State/Zi �b OCA Floor drain/floor sink/hub 16.60 ____ -- Q_, Ga!bagc disposal 16.60 Ph e: - Fax: Hose bib 16.60 NT CONTACT PERSON Ice maker _ 16.60 ame: ` lnterccptor/ easc trap 16.60 Address: X Medical gas-value: S Pa e 2 _ P,imer 16.60 IL Cit /Mate/Zi 1 0 • Roof drain commercial 16.60 Phone:L� "� Fax: _ _ Sink/baain/lavatory. 16.60 Y E-mail: Tub/shower/showerpan16.60 / CONTRACTOR Urinal 16.60 Water closet 16.60 / 9140 Business Name: t,V - SA(-_ �P11 Water heater 16.60 ef 4v fn Address: SUS 2T3,. ._ Other: W City/State/Zi d —? Other: J '7 FaX:t 2 a Plumbing Permit Fees', Phone: subtotal s �_ CCB Li-C. #: Plumb. Lie.#: Minimum Permit Fee$72.50 S . Residential Backflow Minimum Fee$36.25 Authorized Plan Review 25%of Permit Fee S Signature: _ _ ._�__ Date: o State Surcharge(8%of Permit Fee $ TOTAL PERM1!!T FEE S (Please print name) Notice: This perndt application expires If■permit Is not obtained within 180 a:_-after It h.as been accepted as complete. All new Commrct ng require 2 sets of plans with isometric or *Fee, c%idology set by Tri-County Building Industry Servi"Board. riser diagram for Plan review. Plumbine PermiLApplication - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppcession stems: Site Utilities Qty. Fee tta) Total Square Footrges Permit Fee: Footing drain-1"100' _-' SS.t><t 0 to 2,000 $115.00 ^, 2,061 to 3.600 _ $160.00 (rooting drain-each additional 100' 46.40 3 601 to 7 200 $220.00 _ Sewer-I st 100' 55.00 7 201 andater $309.00 Sewer-cr^h additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas S stem3' Water Service-each aciditional 100' 46.40 Valuation: Permit Fee: Storm&Bain Drain-I st 100' 55.00 $1.00 to$5,000,00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to 510,000.00 $72.50 for the first 55,000.00 and 51.52 for each additioml$100.00 or fraction thereof,to and Fixture or Ile Qty. Fee(ea) Total including$10,000.00. Commercial Back flow Prevention Device 46.40 $10,001.00 to$25,000.00 5148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum_permit fee 536.25) 27.55 and including$25 000.00. Rain Drain,single family dwelling 65.25 (� ,i, $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for _ each additional 5100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.00. _ specially requested inspectionsper hour 72.50 $50,001.00 and up $742..00 for the first$50,000.00 and SI.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? If "yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. uantil kr Fixture WolfkPerformed Comments regarding fixture work: Flxture Type: Replace x j _^ i New Moved Exlstln a Cspad_ Baptistry/Font _ '. Bath -Tub/Showc: _ Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thry Cuspidor/Water Aspirator Dishwasher -Commercial M_ -Domestic Drinking Fountain Eye Wash Floor Drain/sink 2" 4" Cor Wash Drain *Note: If the fixture work under this permit results in an Garbage -Domestic increase of sewer EDUs.a sewer permit will be issued apd Disposal -Commercial a -Industrial ^ fees assessed for the sewer increase�Inust be paid before the Cr. Ice Mach./Refri .Drains plumbing permit can he issued. � Oil S aretor Gas Station Rec..Vehicle Du Station _ Sf.owcr -Gang -Stall m Sink -Bar/Lavatory -Bradley W Comttwrcial _J -Service Swimming Pool Filter _ Washer-Clothes Water Extractor _ Water Closet-Toilet Urinal Other Fixtures: Electrical Permit Application Reee;ved Electrical Date/B Permit iJo 1�� a,(�Osl Planning Approval Sign City of Tigard Test Form Dtl/BY: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/D:_____ Permit No.: Post-Review rand Use Phone: 503-639-4171 Fax: 503-598-1960 Date/By: Case No, Interne(: www.ci.tigard.or.us Contact loris: See Page 2 for 24-hour lnspection Request: 503-639-4175 Name/Method: _ SuMlemental Information. TYPE OF WORK _ PLAN REVIEW Please check all that apply) Demolition Service over 225 amps- Health-care facility New construction commercial ❑Hazardous location ddition/alteration/re lacement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION I ec 2 family dwellings four or more residential units in &2-Family dwellingCommereial/Industrial ❑System over 600 volts nominal ene structure ❑Building over three stories ❑Feeders,400 amps or more Accessory Building Multi-Felnil ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder Other: ❑Egress/lighting plan ❑Other: Submit_sets of plans with any of the above. JOB SITE INFORMATION and LOCATION The above are n-i�►plicable to tearer construction service. Job site address: U'3 1 FEE*SCHEDULE. _ Suite#: ��B�Idg./Aptfi: _ Number or inspections er mitallowed_ A Descriptlon Qry Fee tri.) Total Project Name: New residential-single or multi-family per Cross street/Directi ns to Job Site: dwelling unit.includes attached garage. l Service Included: 14s.15 + W G£,�O��� � -�' �sq.A.addless itional e s00 sq.n.or portion thereof 33.40 1 Limited energy,residential _ 75.00 2 Subdivision: Lot#. Limited ever y non residential 75.00 2 _Tax map/parcel#: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 �R Services or feeders-Installation, alteration or relocation: 200 am or less 80.30 201 amps to 400 amps 106.85 -- 401 amps to 600 amps 160.60 2 ROPERTY OWN&R_R TENANT _ 601 to 1000 amps _ 240.60 2 Overr 1000 amps or volts 454.65 2 ame: DA Reconnect only 66.85 2 Address: Z c'(�) � Temporary services or feeders-Installation, �.tv� 77 alteration,or relocation: 66.ss 1 Cit /State/Zi lL� Q>� 1 200 am or less Fax: 201 amps to 400 amps 100.30 2 Phone: �_ -- 133.75 2 ONTACT PERSON 401 to 600 rc s PLICANT •' Branch circuits-new,alteration,or ame: extension per panel: A.pee for branch circuits with purchase of Address: ' servicer feeder fee,each branch circuit 6.65 2 Cit /State Zi iJ ( B.Fee for branch circuits without purchase of service or feeder fee first branch circuit 46.85 2 Phone- Fax: _ Each additional branch circuit 6.65 2 L E-mail Mise.(Service or feeder not included): _ 53.40 2 _ — Each pump or irrigation circle TCONTRACTOR Each sign or outline lighting 53.40 _ 2 Job No: Signal circuit(s)or a limited energy panel,v� - alteration or extension• 75.00 2 Business Name: �'y�,]FF� �l�T-•acL� •Description: Address: V Clt /State/ZI : A Each additional iprpection over the allowable In an of the alrove: Peri ion r hour-min.1 hour _ 62.50 W Phone: Fax: Investigation fee: CCB Lic. #: Lie. #: cher: Supervising electrician Subtotal S signature required:, Plan Review 25%of Permit Fee) S �_ Print Name: Lic.#: State Surcharge 8%of Permit Fee $ __ TOTAL PERMIT FEE S Authorized Notice: This permit application expires If s permit Is not obtained within Signature: Date: Z 180 days after It has been accepted as complete. *Fee methodology set by Trl-County Building Industry Service Board. (PI print name I