Correspondence
Community Development RECEIVED
Request for Permit Action NOV 0:5 2009
CITY OF I RD
TO: CITY OF TIGARD BUILDING DIVISION
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) - I I H U:)A Lk, 91
Mailing Address: ~j l 15 ~ ~ H( £ S L'Z
City/State/Zip: jZip: ~~Ft 21> Oe -7 a 1,
Phone No.: 1503' ~gd'~ 1 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED
❑ CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit ~~aOp9- 002:U~
Site Address or Parcel `~p (~l~ Ct► ~FjM~S ~►J
Project Name:
Subdivision Name: rJrf, Lot _
EXPLANATION: _7t~f_l%u Q-j- Q. A-) k4'Li2 1:~ f~ A6 tT LoA S
(o • ~
Cc-~ LL Q-T"9 t> l~,J17), *1L rLi`t t~0O9-• C0,31
Signature: Date: It 5-6
Print Name: ~~gg (Z ~1) M5~1
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for processing refunds-.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date It 5 Rte to Bldg Admin: Date B
Refund Processed: Date 1116 , p B Invoice Processed: Date B
Permit Canceled: Date B Parcel Tag Added: Date B
Method G Amount $
Receipt # 175dS Date &
I:\Building\Forms\RcgPermitAction. oc Rev 07/26/07
Jit qf 5qa r d (i 1;,~~~ti!>>!~' 13125 9WHall Blvd, o Tigard 01 9,7223 F'
November 6, 2009
Tim Walker
13115 SW St. James Ln.
Tigard, OR 97224
Re: Permit No. MST2009-00207
Dear Mr. Walker:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 13011 SW St. James Ln.
Project Name: Pistor
Job No.: N/A
Refund: ❑ Check # in the amount of
® Credit card "return" receipt in the amount of $136.53.
❑ Trust account "deposit" receipt in the amount of $
Notes: Refund 100% of fire sprinkler fees paid as they were previously collected under
separate permit on PLM2009-00316.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
]:\Building\Refunds\hdniinistraaon\LtrRefund-Overpay.doc 01/16/07
Phone: 503.639.4171 c Fax: 503.684.7297 o www.tigard-or.gov o 7"TYRelay: 503.684.2772
r
s
City of Tigard
Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1-2 weeks for processing.
PAYABLE TO: Tim Walker DATE: 11/5/09
13115 SW St. James Ln.
Tigard, OR 97224 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt 175905 Case MST2009-00207
Date: 11/4/09 Address/Parcel: 13011 SAX/ St. James Ln.
Pay Method: CreditCard Project Name: Pistor
EXPLANATION: Refund 100% of fire sprinkler fees paid as they were collected under separate permit on
PLM2009-00316.
ARE] UNnGiNFORM+.TION:
1 ce Descrtpgon,From"Receipt Rev cnue Accou:nt No.Refund
:taui ,lc : 'BUILD Peanut I ec I '.;aiii le:.< ? 15'0000 132000 nt
Fire Sprinkler 2300000-43101 $121.90
12% State Surcharge 1003100-24001 14.63
TOTAL REFUND: $136.53
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager Ip[q~ i({\ a i({
l
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCELA~SYSTE°M ADMINISTRATION. T, ONLY
Refund Request Reviewed: Date: B :
Case Refund Processed: Date:
n
1:\Building\ltefunds\RefinidRegtiest.doc 04/13/09
111n CITY OF TIGARD MASTER PERMIT
7 : COMMUNITY DEVELOPMENT Permit#: MST20O9 -00207
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2009
Parcel: 2S109AB07600
Jurisdiction: Tigard
Site address: 13011 SW ST JAMES LN
Subdivision: Lot: 0
Project: Pistor
Project Description: Finish basement.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $30,000.00 Rear: 5
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 1
Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckllw Prevntr: 0
MECHANICAL
Fuel Typos Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1
Natural Gas Heat Pump. N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
F u m > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr.
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir:
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
PISTOR, DAVID E FIRST CHOICE CUSTOM HOMES INC
13011 SW ST JAMES LN 13115 SW ST JAMES LN
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503- 709 -7841 PHONE: 503- 880 -7132
FAX:
Total Fees: $1,488.18
This ermit is issued eject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
b done in accordance wi • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
ays. AI"rENTION: Oregon - • equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0011 through OAR • 801 -0 OF You may obtain a copy of the rules or direct questions to OUNC by calling 503.24 6990.332.2344.
/ /gym --_ ued By: Permittee Signature:
•
Building Permit Application / E yPf7?t'7L
Residential RECE\(ED Received I R UOFFICE OFFICE uSI': OiNl.l
City of Ti and Q Permit No.: 90
'
° 13125 SW Hall Blvd., Tigard, OR 9 q3 7 2009 Plan Revie '
II Phone: 503.639.4171 Fax: 503.5919 9 60 'a Date/B : �_ ! r Sher Permit.
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: FM Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X Addition/alteration/replacement El Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
X 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 3°, op
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: t 30 \ \ S (...) S-T" S t El LAD New dwelling area: i 35o' square feet
City /State/ZIP: "'r" 1 G At ,rJ Olt ct'} Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: Covered porch area: — square feet
Cross street/directions to job site: Deck area: — square feet
3 t T 4- -Other structure area: — square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
.r}a 1.& . 11 T-01 PVT. Valuation: $
Existing building area: square feet
New building area: square feet a
❑ PROPERTY OWNER I ❑ TENANT Number of stories: ,
Name: Y pa LSTorp__ Type of construction:
Address: \ 30 \ 1 S lJ 'C' - Arvl ES LC) Occupancy groups:
City/State /ZIP: -n 4 Atu3 9 9- 2.-7..-4- Existing:
Phone: (S0a ) "709 - 784 1 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ¶tQ3^r oKo ir _ g _ cus,Tdwl how Er b&)L All contractors and subcontractors are required to be
Contact name: A K.- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
• Address: 13 its S 1.A ST 'We, At gc L W jurisdiction in which work is being performed. If the
City/State /ZIP: 'T1 e Avt o D/_ Gl 9 22 4 applicant is exempt from licensing, the following reasons
p � apply:
Phone: (yep ) t�E0 ---) L3 Z Fax: : (S °3) g Z1 CQ 4 C
E -mail: ' Q.ra-AM' tJILa 11+L14O■•5X t cos.* 1. CO'.
CONTRACTOR
Business name: T 1(I,S GAD I CT. Cus.Tv v Ravi j /4.)c- BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State/ZIP:
Q FLS plan review fee (if applicable):
Phone:,(C ) ago '7l3 Z I Fax: (Sd3) 902A - C4ra -Z
CCB lie.: 13 83 2A Total fees due upon application:
Amount received: 33.0 • 8f3
Authorized signature: T This permit application expires if a permit is not obtained
f f ,-, within 180 days after it has been accepted as complete.
Print name: I iM Wkt K-ge‘. I Date: I p 71„, oat • Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 4404613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling roR OFFICE USE ONLY • City of Tigard - Received Permit No.:
. V 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By:
C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
24- Hour Inspection Line: 503.639.4175 El Electrical ❑ Plumbing ❑ Mechanical
"I'IGAItI)
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR FLAN REVIEW Yes No NA
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ i
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ .0"
3 Verification of approved plat/lot. ❑ ❑ •"
4 Fire district approval required. Name of district: — 1 — VT . R.. • ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ .Er
6 Sewer permit. • ❑ ❑ 2-
7 Water district approval. ❑ ❑ .0r
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ 0
9 Erosion control a plan 12 permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ /2'
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance.to applicable local and state J X ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size .
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 corner elevations (if ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations;• direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage. );Si. 2 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size El R'
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, X ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 C ross sections) and details. Sh ow all framing- member sizes and spacing such as floor beams, headers, joists, sub- i ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray • ' •
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, 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 indicate details and locations; for non ❑ ❑ ` Tir
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 . 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. 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 X ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load. • • • ' .
20 Manufactured floor /roof truss design details. . ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or. ' . j ❑ ❑
architect licensed in Ore on and shall be shown to be applicable to the project under review.
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ' ❑ `
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. 0 ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ,
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 2r ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. , /❑� ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑
Street plan i Tree
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval. .
' 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ J
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
IABuitding \Permits\BUP- RES- PermitApp.doe 03/21/06 440-4613T(11 /02/COMWEB)
•0tT -26 2009(M0N) 10:38 Bear Electric (FRX)5036781108 P. 001 /001
Electrical Permit Applicatlo rE � CEIVED . F OR OFFICE USE ONLY
WI
City or . ( navv■vl T 2 7 2009 t4h 11, io a/ P a _ 1 / • Perm' Nn a , „f .7
71 .- r 11122 3 s W I lal Rind., Tigard, OR 9 New Ne..�.
Phone 5(1.3.63').4171 F'ae • 511.1 ' I r ,. tw . lt _ nowt I cti ul
T ICAIt 0 ln`pciaina Line' S11,1,6.1v.4175 C OF TIGARD 1 IbiKkad.:ii, I t —.tic, en� titrat4kr
Itllelllel "w tigard,.ttlus BUILDING DIVISION '- 1 ' " m611j.+1... _... .. _ _., � l'r
tiappirawatel tolarmatt.ta
TYPE OF WUKK . - -._ • ' ._ 1
Q New l'i,Ii tr11411t'n Y- Addllinli/allr:roliufl/ 1lueerlicnt I 1'Ita+r cheek all that apply (submit L ielsnl plum wears (NOW brio..)
. rc1 1. Oso . lee n tiVIICI 4 worst+, rnore 0lwildme owe over almet I
❑ Demolition ❑ Qlher. nherr !be a■silahla limit current 0 Mantas and bcsagarda
II .-. .. :CATECORY'OF: CONSTRUCTION . ' 1 C c44ltlaonamp) II 110volnat ❑Runletbw4dinin.
F --V • ^•. - ......._ ...I kc.s w i aamr. w creed. I4,0 0 Cnutwemal•tot otpsc ul h vn)
' and 2-family dwelling ❑ Commaci3Uindustrial ❑ Accessory httildilil: i meat 6,t all ...an ineallatloas. bnild•net •
0 Mtltlj•IhmiIa ❑ Mailer huildcr ❑ Other: � CJ rirr pump Q lttoalbluatorl5 l:VAnr
• - •110K - - y1' t t Nb . LOCA'It1O\ �' — • y —� ❑ I;tatnanei.islew Irrtler +e0onaelrtle+nedfy tu.
tt Additiouarm *m or 0foalor Q"A", • I :` "1•t',
I Joh no : J Jnh site address; k1411 lr . mot. curincr•
- - ^ ---............... CI Si' as mntr n•snkmiat ones. Rearatian4l wank yaks.
City /Stulc/ZI }'; 13ou S L -err -- Z�'i CA, . 0liramtiam (wanks nks ❑ Simply .ultora la mum than
.. .. ... ... .... ... 0Ila,an1uut Iceation, WO spite nominal.
Suila'hldg,lnpl, nu.: . I'nljeel name: 1 D SrtvlCe ot feed') t o anln re mot e. -. ' . •
l n>s,iruUdIrrt liana to jnh site: • t . . - nth` $01013tg:" = ;= "em u.:' = .
' """" ..'-" New reshlential sliver. or niuIii4gntlly dwelling unit. •
' 3 L .S . lnettnit% situated garage.
Subdivision: i Lot rich: _ 1 sq. R. to less • 168.34 4
• E4. add' l' 500 sq. 11. a portion - - .33.92 i
'l':tx.tnapJpareel no.: i Lnuiled energy, rt,Wcnital
. • , fESC10PT10ti=:Oi- f,►0Rk ;$...T rwitb obese s II.) • •
I :suited enemy, multi•I'amily .
71 ISA, 734-0-1— re%iapniatl (with als,we a4 11) . 67.81 . 2
-- Semites orlteders installnllon .alleratlon
call
_ v.
200 Lamp: or 1 7u 2 •.....,. .= �_. tAQPLICI`1 OSVN'!:R': ` . .. - - r.. , y Q"a'F,14A$T? _ : :.. 20) amps: to 400 nmpn • . . . 133,56 - .. • .2
NalIM INL.192... ' liS1 t) (e.- 4,111 amps to 6110 an not :00,3•1 '
- -- - - - - -- - -- --- '-- •••••- 641 amps to 1,000 amps 301.041
Address: tO 11.. ....C. W ..s—c ...is/yj iz 4.4..) Ova 1.000 amps or volts • . • 552.26 2
-
Cityititntd %JP —S'lG /.4./(c .91—'22.-4 --'femporaryscrsitri cedertifttatallatbn .niterntlon.andler
Fee ar rant
_ relocaWle .
Phone: (.$ .) Fax:.( . j 200 2.,.. of 1.� 59.36
7o - 7.
Owner installafioau Fhis inst Lion ix being made on property -that 1 urn _ which Is not , 201 amp Iu 400 alnPs . . - 123.06
iritcndcd for sale, lease_ rent, or mehunge. nevonling' In ORS 447, 449, 6711, and 701. 401 tangs to 599 aaipn - ` ' 16ll:i4 1
2
ounersignature: . _.... -Dole:
r J1 r�nclfeib Il h c i rcut nerr,� .rr
ghrr4 r>tiir tine nluoi Paid
r
-T
- - .. ..... 0: AP1'UC N 1 ii* _ =' _; _ : ' = -i; .. , Col i1 C P •;i±FICSON:. : i aMwe sen•iee nr ieedr r Fee: •
.raeh branch cireon .7 4z _
OttsineSs n.irne ll. Fce for brwxhcircuits •
w it /a,ut stn ice or feeder fry � 1
l (ulhxl name: _ - 36.1R " Yt ` S
lint hmnch tutee •
Address:. Each add'1 branch circuit . 9,42 ip(or" 2 1
• - -- -- -- - -. •--- -�-- -- -- - + hilsedtnoeoaa - {!errles ur f►wter nothle_trtprd? "
•
CilyiS 17.5P: lin�C i mamrlbautrd w nrwdular 67 �
due0in, service nnd'or feciter
P ( . - :..._.. � _..._..��__ _ }'a,:: ( .) - licctiutuxl only 2
Ii•r il: Pum or irrigntinrl eircle 2 • " _ 'a3's r =;'.- ... .. -...- - Sir ut oulliac1ifd111ng 67.84 • . 2
Rosiness name ' t- �.r .Sigrid circuins) nr limited• - •
� i� tt..L.E..+✓L.1., � C,.... -.- away panel, alteration, or .
Address; b��••rr�� ��Y t5I ii.inn. fkxcrd*e Pate► •
• •
City/State/ZIP: ' � _ c^\ Q �_ Frcli ndrl►tlulml.inipectin I orar allrrwabte in aav of Ilss above
t ,, ` p� .1 p irupcetlan � __ 66.2 3
•
•
I Inane cl �l �� ._ .... Fa G �� til rG ‘0 O...... 4 Imartigolkm per hula (1 hr min)' NM=
CCli.l ic,.0C, Electrical Lic.:2L.f . O7 T'Supsv. L.ic.:1..` • $`^a Ind ?Li11myler ltota � i
Supra. L'iearicirn gilature quiraf: 4 '` , � ' ;::1~t:T 6 a " '�5 -''= .r `ot - Ng-
m Eta ate: . r e . ( )alG . at' % l K. 2 � - 5 «Arch e(u �r : �v
Pri
Authotizedsignture:. \ � L 0 ` `. J Tdt'ALLON.IFF.'F6 1- I
Ptint name: I �J.. Date:. The. pI rntl applk *Wru arl irra Item-rink 1a?hot . • • • d area (Na
j don ±Rrr k lux bye acceprd as camplNw.
. ' .... • tratnhtrol 'mop mt
tenonsaaloii¢ilperp •
Ian ;s4e;Jtaau'ritCa4t114l11tip.doi rjMiamo• itll.tats - rn ems- tlMmt - en. '
•
Mechanical Permit Application RECE11/ a
a FOR OFFICE USE ONLY
City of Tigard OC T 2 7 Daze/By: /04
q 13125 SW Hall Blvd., Tigard, OR 97223 200'
Permit No.: N 9 � 4, :�
Phone: 503.639.4171 Fax: 503.598.1960 C�r •�� Plan Review Date/By: Other Permit:
BU I LDIN G DI Notified/Method: FM Supplemental Information
val.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction %Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
�1 -and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory b uilding
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
30 I I S
Air
Job site address:
` �A � �S L� (requires site plan showing placement) 46.75
City/State/ZIP: Ti 6 A /(- O ft_ 9 9-z Z ¢ Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
1 . 3 1 4-x- Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32 _
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace I 33.39 , , '
Flue vent for water heater or gas
�1.J/S K 17AS lrMX�T fireplace 23.32
r /
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
[PROPERTY OWNER I ❑ TENANT Chim y/liner /flue/vent 23.32
// Other: 23.32
Name: 2) AVg- Pis TO /2 Environmental exhaust and ventilation
Address: Range hood/other kitchen
/ v1. 1E_ equipment 33.39
City /State /ZIP: Clothes dryer exhaust 1 33.39 3331
Single -duct exhaust (bathrooms,
Phone: ( spa) - C1 - 7 ? 4_ l Fax: ( ) toilet compartments, utility rooms) I 23.32 z3.
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc IA, I'S
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace I
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: A - 4 ' ) cH r4 4 CLE Other:
Address: /"e C ST- Ti v 726 wo S I MECHANICAL PERMIT FEES"
City /State/ZIP: GL 4e. ni 4.s OK ! 7D is Subtotal 1CA,
Phone: 5031 ( 5O - so ? Fax: Eat )$,S Minimum permit fee ($90.0
p� 2 T Plan review (25% of permit fee)
)
CCB lic.: -7 � 4 1 D State surcharge (12% of permit fee) 1 A j I
- ,`-fffe,, - Tecn / . TOTAL PERMIT FEE 1 1 10,1 6
Authorized signature: e This permit application expires If a permit is not obtained within 180
�St] 3. � 4' / days after,it has been accepted as complete.
'€
Print name: R I SA) 11
y p -_ ( Date: I • Fee methodology s,f by Tri -County Building industry Service Board
/
I:1 Building \Permits\MEC- PermitApp.doc 10/01/09 440-4617T(II /02/COM/WEB) ,
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
I:\BuildingWermits.MEC- PermitApp.doc 10/01/09 2
- REC EIVED
Plumbing Permit Application
Building Fixtures OCT 2 7 200 I OK OFI ICI: USE ()NIA'
City of Tigard CITY Received
i Permil No.: hTe{QQ pp�0
h' g OF TIGARD Date/By: /D o77 p 9 7
IN a 13125 SW Hall Blvd., TigardB amkr; DIVISION Plan R
Phone: 503.639.4171 Fax: 503.59 . Other Permit No.:
Plan Review e Date/By:
T I G A It D Inspection Line: 503.639 Date Ready/By: r ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: , / Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
Description I Qty. I Ea. I Total
X Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
Y CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
om- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath I 437.78
❑ Accessory buildin g ❑ Multi-family
SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler ( 13 Q sq. ft.) Page 2 k2� ,90
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 130 It Su) C� SA A pc. L Catch basin or area drain 18.76
1, leach line, or trench drain
City / State/ZIP: - cv O 61 4 22- r r Footing _
1 Footing drain (no. linear ft.: ) Page age 2 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
L3 1 ST w I L Lag rukto w Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer I 25.02 2541) 2
FIN %S H. 11 sril TYAd tl-- Dishwasher N b 25.02
Drinking fountain 25.02
Ejectors /sump ( 25.02 2.,,OZ.
,PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Iv T- P Sit Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: < ,\ 1 M� Garbage disposal 1 25.02 , �L
City /State /ZIP: 6� Hose bib 25.02
Phone: ISYN 709 -- 78 4 I Fax: ( ) Ice maker ( 12.51 I2 .5(
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address:
Sink /basin /lavatory(- s•i 'g 25.02 ,0 ?
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan ' 12.51 1Z, 5(
E -mail: Urinal 25.02
CONTRACTOR Water closet 1 25.02 7/5,62..,
Water heater 'L'XL V 11.01 37.52
Business name: 1) e(_Ti , P 1 l {x) �� 1 N L Water piping/DWV 56.29
Address: Other: 25.02
City/ State/ZIP: Subtotal ( Z ?.
Phone: $�?3 _r ) co g -734_1_ Fax: ( ) Minimum permit fee: $72.50 l
CCB Lic.: ' S'LF 4C� lambing Lic. no.: S(QZ Plan review (25 % of permit fee)
State surcharge (12% of permit fee) 3'5 (A...
Authorized signature: TOTAL PERMIT FEE :32
Print name: 7 Al I - 1106 ,) Date: /0 O This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1: Building \Permits\PLMU- PennitApp.doc 10/01/09 440- 4616T(l0/04/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $ 169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
- 3" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF- PermitApp.doc 2
City ly r lry p 9 4 t - h "'E ,
,'r. �l o Tigard y Cnf/l. 31 yi 5 7 Hall Blvd. Tigard 9 7 223 t
• •
November 6, 2009
Tim Walker
13115 SW St. James Ln.
Tigard, OR 97224
Re: Permit No. MSi2009 -00207
Dear Mr. Walker:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 13011 S \X/ St. James Ln.
Project Name: Pistor
Job No.: N/A
Refund: ❑ Check # in the amount of $
E Credit card "return" receipt in the amount of $136.53.
❑ Trust account "deposit" receipt in the amount of $
Notes: Refund 100% of fire sprinkler fees paid as they were previously collected under
separate permit on PLM2009- 00316.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
l: \Buildin Refunds\A dminisiration \LtrRefund- overpa 01 / 16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772
1 , 1 q
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit/I ction or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Tim Walker DATE: 11/5/09
13115 SW St. James Ln.
Tigard, OR 97224 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 175905 Case #: MST2009 -00207
Date: 11/4/09 Address /Parcel: 13011 SW St. James Ln.
Pay Method: CreditCard Project Name: Pistor
EXPLANATION: Refund 100% of fire sprinkler fees paid as they were collected under separate permit on
PLM2009- 00316.
REFUND INFORMATION: •
Fee Description From. Receipt • Revenue Account No. -. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
Fire Sprinkler 2300000 -43101 $121.90
12% State Surcharge 1003100 -24001 14.63
TOTAL REFUND: $136.53
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
1/111,, i t� ` .
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
• FOR ACCELA SYSTEM ADMINISTRATION USE. ONLY . •
Refund Request Reviewed: Date: /7/4/', Bv:
Case Refund Processed: Date: � � By:
l f
I: \Building \Refunds \RefundRequest.doc 04/13/09
. Il
1 1 4 Community Development RECEIVED
T l c A lZ Request for Permit Action NOV 0 5 2009
CITY OF TIGARD
TO: CITY OF TIGARD BUILDING DIVISION
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor `t" City Staff
(check one)
REFUND OR Name: �
INVOICE TO: (Business or Individual) - I I i L3 Lk Q
Mailing Address: 1 t I t..) r J AH£5
City/State /Zip: --6 oQ. 9-7 2-2.4
Phone No.: 5D3 - $SO' . 113 a
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: NISr ooc3- OOaU-'
Site Address or Parcel #: 1 '6 1 i u 3 `ar." -1 5
Project Name: — Pt 1 .. r (2-.
Subdivision Name: ri/k Lot #: Ij'ii-
EXPLANATION: 4FtA ►JI != t (Zt_ `aA2 t ,. 1s.0 2 . E.€ 1 rr loq 5
Ce .LE eTf t ) L 3 r, tit Pu-1 good - o031 . F
✓�� ,x . , , - 77 r/ K Z7a3 - 6P a/ -6e/ . 1T / �� /a ?
Si gnat u re: ' a Date: ii 516 9
Print Name: X0,61 C Q. ( t"). 1 DK)
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date nallIL ,II] Rte to Bld. Admin: Date / /AMON B ;4,s-
Refund Processed: Date /% 6 .O • B ,,.%7 Invoice Processed: Date B
Permit Canceled: Date ' /f— By ,' ' Parcel Tag Added: Date By
Receipt # /759oS' Date,/ � j� Method G� Amount $
1: \ Building \ Forms \Regl'ermitAction.. oc Rev 07/26/07