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CITY OF T;GARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested �J l AM PM
Location ` 7G; Z Gr71- Suite r Eg Q_G�p l
Contact Person � _ Ph C e _ O (LMJl
Contractor "�Uutts . � 1 _ P 7 7 SWR _
BUILDING Tenant/Owner _ _ ' _ ELC _
Regaining Wall - E:LR
Footing Access: -i
Foundation. - FPS
Ftg Drain - � — -----
Drain Inspection tes: Y r - SIN
Slab =--A-�
Slab I�4.��_" -�� SIT
'
Post& Beam -
Ext SheathiShear 9
Int Sheath/Shear - -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm -------- ---_-- --
Susp'd Ceiling ---- - ---- ----- ----—
M i sc: --- - --------- --- —
Final -
P ARJ FAIL - ---- ---- - —
PLU
r-OST1 Bears _ _ _-_--
Under Slab
Top Out
Water Service �" n
Sanitary Sewer _
grains
AS _ FAIL
NIC
Post- Bearr. jp&_5 - —
Rough In
Gas Line SWAP-pampers - 7' v
PAS PART FAIL
ttl�CTRICAL - -- — -
Service
Rough In ---- -- --------- --- ---- --
UG/Slab —_— -_.- --- - -
Low Voltage
Fire Alarm
------------- ---------
Final -'� _---_--------- -.�-- - -----
PASS PART FAIL -- -- - _.-_.. ---- - -----------SITE
Backfill/Grading ---- ----..� -- -------- ----- - --
Sanitary Sewer
Storrs Drain [ ]Reinspection fee of$ _ _ required before naxt inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: T_ -- ( )Unable to inspect-no access
ADA -�
Approach/Sidewalk n �`j
S
Other Date ___Inspector `' �_�— __ _ Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITYOF T I G A R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00051
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/7/01
PARCEL: 1 S135CD-05600
SITE ADDRESS: 09702 SW LONDON CT
SUBDIVISION: LONDON SQUARE NO.2 ZONING: R-25
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
FUEL TYPES _ 0 3 HP: DOMES. INCIN:
LPG 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + Hp: CLO DRYERS:
FURN < 100K BTU: _ AIR HANDLING UNITS _ OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfrn: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas piping and gas insert.
Owner: FEES
SHANNON, ARLEEN M Type By _ Date Amount Receipt
9,702 SW LONDON CT PRMT CTR 2/7/01 $72.50 27200100( '
TIGARD, OR 97223 5PCT CTR 2/7/01 $5.80 272001001, .
Total $78.30 --1
Phone: —"�—
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 _ _ REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-234-7331 Mechanical Insp
Reg#:LIC 1441 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION. Oregon law requires you to fallow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001.-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (5 )240-9189.
1 �
Issue B Permittee Signature:
Call (503) 39-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received:, -5-0/ Permit no.:d
Cit of Tigard City g ProjecUappl.no,: Expire date:
0h. 111:a1d Address: 13125 SW Hall Blvd.Tipard,OR .97223 1'9'
Phone: (503) 639-4171 C� �yQq Date issued: By: Receipt no.:
Fax.: (503) 598-1960 O�a� Case file no.: Payment type:
Ladd use approval: Building permit no.:
TVPE OF
$c 2 family dwelling or accessot), U Commercial/industrial U Multi-fancily LI Tenaw improvcniew
U New construction U Addition/ulte:alion/replacement U Other.
INFORMATIONJOB SITE COMMERCIAL VALUATION S('111-"I)ItlE
Job address: T7 C-1.2 W LQ.w Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: Block: I Subdivision: "See checklist for important application information and
project name: Z LE jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: ME= Matikillou
Description and location of wo�•k qn remises: 1
I VL TH It. it Nerl ) , — Fec(Mr.) boost
Est.date of completion/inspection: Description (Py. Res.only Res.mtly
Tenant improvement or change of use; C:
Is existing space heated or conditioned?U Yes U No Air handling unit _ CFM
Is existing space insnlalcd. U Yes U No Aircondttioning(site plan require ) -
gt.tation of existing C system
P:,.Tie r compressors --
Business name: e( I.t,r Stdtc boiler permit no.:
Address: 11 L IIP Tons BTUAl
`7 �� rir smo•e dampers/duct smoke detectors
City: ..' State: ) ZIP Q,;L Ileat pump(site p an rc-qt cd) -_ -----
Phone: j e - Fax: C mail_ InstalUreplace furnac urner_� TWIT
CCB no ).q �,? _ Including ductwork/vent liner U Yes U No
nsta rep ace re ovate heaters-suspen c ,
City/metro lic.no.: �_ wall,or floor mounted
Name(plcase print):.`j1 /V'/ ( C'aLl ( Vent forapplianceof err an furnace
of getsilun:
CONTUIPERSON Ahsorpdon units
Name: Chillers
— Com ressor,, _ III
Address: - t ;nv ronmenta ex must an ventilation:
City_ ( State: ZIP: Appliancevent
Phone: Fax: I'3 -4j5- -mail: jryerex aunt
no s.''ypc res. rte en azmat
hood fire suppression system
Name: f-� L e_F rj Exhaust fan with single duct(hath fans)
Lxhaust system aarMailingaddress: r Q from testing or AC -^-
City_ State: 7.1P: 7d,7 -Turl piping an st ut on(up to 4 out els) �U
Type: LPG NG Oil J
Phone:(0 3 /�/� Fax: IE-mail Fuelpiping each additional over 4 outlets `
Process piping(schematic require )
Name: Number of outlets _
-- ter NAM appliance or equipment:
Address: Decorative fireplace CI
City: State: ZIP: Insert-type r T-
Phone: Fax: E-mail: Woodslove/pcl let stove
Applicant's signature: [)ale: er-
Name (print):
Not all jurisdictiom accept credit cad+,please call jurisdiction tot mote information Permit fee.....................$
LJ Visa U MasterCard Notice:This permit application Minimum fee................1, - ICA cad number: �_� expires if a permit is not obtained Plan review(at — %) $ _
Expire, within 180 days after it has been State surcharge(8%)....$ - -
Name of cardholder axe own on credit card accepted as complete.
_
$
TOTAI. .......................$ o
Cardholder signature Amouni _ 440.4617(ISM/COM)
?3.;)0 ,T
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: uescriphon: - Price Totai
$1.00 to$5,000.00 Minimum fee$72.50 Table 1.A Mechanical- de v Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or including ducts&vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts&vents T 1740 -
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 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 Poor 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 A0
fraction thereof,to and Including 6) Repair units
$50,000.00. _ _ 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Chec;k all that apply Boiler Heat Air
$1.20 for each additional$100.00 or For items 7-11,see or Pump Cond
fraction thereof. footnotes below. Corn
7)<3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 1001:BTU _ 14 nn
8)3-15 HP;absorb
Value Total unit 100k to 500k BTU _ 25.60 _
Descrl tion: Q Ea Amount g)15-30 HP;absorb
Fumace to 100,000 BTU,Including 955 unit.5-1 mil BTU 3500----
ducts
500 _ducts&vents 10)30-50 HP;absorb
Furnace>100,000 BTU Including 1.170 unit 1-1.75 mil BTU 52.20 _
ducts&vents - 11)>50HP:absorb
Floor fumace including vent 955 unit>1.75 mil BTU 87.20 _
Suspended heater,wall heater or 855 12)Air handling unit to 10,000 CFM
floor mounted heater _ _ _ 10.00
'Vent not included in applicance 445 13)Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 _ 10.00 _
to 100k BTU 15)Vent fan connecter'to a single duct
3-15 hp;absorb.unit, 1,700 9,80
101It to 500k BTU 16)Ventilation system not Included in
15-30 hp;absorb.unit,501k to 1 2,310 appliance permit
mil.BTU 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3,400 10.00
1-1.75 mll.BTU 18)Domestic Incinerators
>50 hp;absorb,unit, 5,725 17.40
>1.75 mil.BTU 19)Commercial or Industr?al type Incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit>10,000 cfm 1,170 20)Other units,including wood stoves
Non-portable evaporate cooler 656 _ _ 10.00 _
Vent fan connected to a single duct 446 21)Gas piping one to four outlets
Vent system not Included in 656 540
appliance permit 22)More than 4-per outlet(each)
Hood served by mechanical exhaust 656 1,00
Domestic Incinerator 1,170 Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit,Including wood stoves, 656 8%State Surcharge $
Inserts,etc.
Gas piping 1-4 outlets 360 - 25%Plan Review Fee(of subtotal) $
Each additional outlet 63 _._ Required for ALL commercial permits only
TOTAL COMMERCIAL_ $ TOTAL RESIDENTIAL_ PERMIT
VALUATION: _ 71 _
Other Inspections and Fogs:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72.50 per hour.
2 Inspections for which no fee Is specifically indicated (minimum charge-half hour)
$72 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
"State Contractor Boller Certification required for units>200k BTU.
"Residential A/C requires site pian showing placement of unit.
I:Wsts\forms\mech-fees.doc 10/11/00
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00069
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/9/01
SITE ADDRESS: 09702 SW LONDON CT PARCEL: 1S135CD-05600
SUBDIVISION: LONDON SQUARE NO.2 ZONING: R-25
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBiLE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace gas water heater.
FEES
Owner: r
Type By Date Amount Receipt
SHANNON, ARLEEN M — - —
9702 SW LONDON CT PRMT CTR 3/9/01 $72.50 27200100000
TIGARD, OR 97223 5PCT_ CTR 3/9101 _ $5.80 27200100000
Total $78.30
Phone 1:
Contractor:
WRIGHTS PLUMBING
3725 SE OLSEN ST
MILWAUKIE, OR 972.22 REQUIRED INSPECTIONS
Phone 1: 503-449-8418 Final Inspection
Reg#: LIC 129671
PLM 26-645PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center Those rules are set forth in OAR 952.0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By:.- - {C` Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bi,416ess day
Plumbing Permit Application �
r Datereccived: �; � O Permit no.1&.-/_7Cj11•- 1) <�
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City ofTigard phone: (503) 639-4171 ProjecUappl.no.: Expired�tc:
Fax: (503) 598-1960 � � ( Date issued: Bytl'>,;,,I Receipt no.:
Land use approval: %r0/ - �00��/ Case file no.; Payment type:
pd I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Focxl service U Other:
.1011 SITE INFORMATION SVIIII)i I.L.ffor%I?echil hirormallon u%e che,cklist)
Descrl . Fec(ea.)
Job address: U rjW 1 CX-L�1 CT---� — tion Qt 'Cola.
Bldg.no.. — � Suite no.:- -- New]-and 2-family dwellings only:
- (includes 100 ft.for each utility connection)
Tax trap/lax Iottaccount no.: SFR(1)bath
Lot: Block: Subdivision: _ SFR(2)bath
Project name: _ SFR(3)hath -
City/county: T% p 71P Each additional bath/kitchen
Description and oca it
of work on premises: - Site utilities:
C- v 1� L�aEX H�j¢ ,�_ a S_ Catch basit>/arca drain - -
,� �U�"� -- Drywells/leach line/trench drain
Est.date of cc�tion/inspection: - --
_Footing drain(no. lin. ft.)
Manufactured home utilities _
Business name: --f--1 f,p{ Manholes
Address: ?j -19"s Sc O1 _ Rain drain connector
Cit Slate 71Fti Sanitary sewer(no. lin. ft.) -
Y•�y'"-- Statin sewer(no. lin.ft.}
Phone: 5Gj ]Qy . . Fax: E-mail: _ --- -
CCB no.: /,Z y(p�) Plumb.bus.reg_no: 2 U-Gclr$ Water service m, lin.ft.)
_Cityhnetro tic.no.: ' ' ��dc ,, i�i ^•n ;0 Fixture or Item,
Absorpti3n valve
Contractor's representative signature: / Back flow preventer
Print name: (,c>K l t= D _V Backwater valve
Basins/lavatory - -- _
Name: Clothes washer -`
- - - Dishwasher
Address -_ Drinking fountain(s)
City: - _ State: zip: Ejectors/sump _
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
Name(print): ^ ,�, `` ,, V - Floor drains/floor sinks/hub _
R 1 t -�-- - Garbage disposal _
Mailing address: _ 9 70;Z St.r carte
— 1r1t�C Hose bibh
Cit State• ?_IP: -" -
y:-�1 c4"L b$Z � Ice maker
Phone: Fax: E-mail: Intewe for/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) - -
employee on the property 1 own as per ORS Chapter 447. Sink(s),basis(s),lays(s)
Owner's signature: Date: _ Sump _-
Tubs/shower/shower pan
Urinal
Name: --------
--�-_ V',,tercloset _
Address: _ Water heater ----- - -
City: - - State: 7,IP: Other: - --
Phone: Fax: TE-mall Total
Not all jurisdictions accept credit cards,plew call jurisdiction for more information. Minimum fee................$
Notice:This pcnnn application plan review(al _ %) $
U Visa U MasterCard expires if o permit is not obtained
Credit card number: _--._ _ _— a/ / ithi1 RO days after it lilts been State surr_harge(8%) ....$
F. _
p wn accepted as complete. TOTAL, .......................$ / 3 O
Name of csadholder aishnwn on credit cmd iv -
S
Cardholder sitpiature --�— - Amount - 440-1616(ISWCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-famlly dwellings 11nly:
FIXTURES (Individual)..__ QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the f1rst100 ft. QTY (ea) AMOUNT
16 60 for each utllity connection
Lavatory Qne�1) th $249.20
Tub or Tub/Shower Comb. 16.60 bath
_ $350.00
Two 2 ba
Shower Only 16.60 Three 3 ball �- -_ - $399.00
Water Closet 16.60 _ SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL _Y
TOTAL
Garbage Disposal - 16.60
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3^ 16,60
4°
Water Heater O conversion O like kind _ 16.60 Quandt b Work Performed
Gas piping r iquires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit, --7--'
Capped
MFG Horne New Water Service 46.40 Sink
MFG Home New SardStorm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 _ Combination
Root 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-1 sl 100' --- 55.00 ---- - 3" _
Sewer-each additional 100' J 46.40 4"
Water Service-1st 100' � � 55.00 - Water Heater
_ -- Other Fixtures
Water Service-each additional 200' 46.40 v ed
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' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections _ _perlhr _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps - - 1660 _ ---- -
QUANTITY TOTAL � - �_
Isometric or riser diagram Is required if
_
Quantity Total Is >9 -
*SUBTOTAL -
8%STATE SURCHARGE - -
"PLAN REVIEW 25%OF SUBTOTAL
Required only II fixture qty total Is_.9
TOTAL. 5
"Minimum pem It fee i,$7"!50 4 tl%state surcharge,except Residential @ack8ow
Prevention Devine,which in$30 25�8%state surcharge
"All New Commercial Buildings require plans with Isometric,or riser diagram and
plan review
is\dsL9\forms\plm-fees,doe 10/10/00