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Permit kiprini .74 CITY OF TIGARD MASTER PERMIT • ' COMMUNITY DEVELOPMENT Permit#: MST2009 -00225 T r G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/22/2009 Parcel: 2S102CC00316 Jurisdiction: Tigard Site address: 13450 SW CRESMER DR Subdivision: CRESMER HILL Lot: 15 Project: Barkhuff Project Description: 232 sq ft addition. 1/8/10 ADDED gas line to permit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First 232 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: $23,652.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvelFeeders 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'I Br Cir. 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +ampNolt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & 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) LI, TIANCONG & ADVANCED CONSTRUCTION & BARKHUFF, JORDAN M, 13450 SW REPAIR LLC CRESMER DR 13450 SW CRESMER DR TIGARD, OR 97223 Tigard, OR 97223 PHONE: 503 -841 -1323 PHONE: 503 -841 -1323 FAX: Total Fees: $1,240.14 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: Q Q 3'10P CITY OF TIGARD MASTER PERMIT �' ' a Permit #: MST2009 -00225 • COM DE VEL OP MEN T i j Date Issued: 12/22/2009 T [ GARL); 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102CC00316 Jurisdiction: Tigard Site address: 13450 SW CRESMER DR Subdivision: CRESMER HILL Lot: 15 Project: Barkhuff Project Description: 232 sq ft addition BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 232 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: $23,652.00 Rear 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add] 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 & 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) LI, TIANCONG & ADVANCED CONSTRUCTION & BARKHUFF, JORDAN M, 13450 SW REPAIR LLC CRESMER DR 13450 SW CRESMER DR TIGARD, OR 97223 Tigard, OR 97223 PHONE: 503 - 841 -1323 PHONE: 503- 841 -1323 FAX: Total Fees: $1,224.29 This • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wit b- one in accordance 'th al:). i•ved 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. ATTENTION: Oregon -w r'•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 t rough OAR : 101-010e. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.33 344. Issued By: e /.� ' ��: i Permittee Signature: V , Building Permit Application Residential i * } FOR OFFICE USE ONLI',w+ r lig C ity of Tigard Date Received ad/ �ig Permit No.: /lr� „9....e0,2,25--- ° 13125 SW Hall Blvd., Tigard, OR 97 Plan Review a' - � Phone: 503.639.4171 Fax: 503.598.1 0., Q.� 20 9 DateBy: Fr l 2,. I"' 0 Other Permit: T l G'n ?D Inspection Line: 503.639.4175 Date Ready /By: ' � , Juri Ei See Page 2 for .. - -::4; r Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: (a j9.. ( 1 /a Supplemental Information _...... __ . . . , . . _._ TYPE OF -WORK _ - . ._ .- - -... _ .._ ,..._ _...,. _.. :...:- _REQ D DATA:1- AND 2- FAMILY DWELLING • ew- cottzitr -- — ea" ❑ Demolition Permit fee are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the . CATEGORY OF CONSTRUCTION - work indicated on this application. / j 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ,c9 ✓ GQ�a . seo ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION . . . Total number of floors: Job site address: / 3 y 5 O 5 O 1. /-. New dwelling area: a 3 2 square feet City /State /ZIP: 'T. A'I G 2 '9'7? 2 ) Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Ar r k4 u ff /1661,/i o/1 Covered porch area: square feet Cross street/directions to job site: /t/ (A H4 /, Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: /n ►� n //��� I Lot no.: Permit fees* are based on the value of the work performed. l�l.-W Tax map /parcel no.: A 5 10 a 31 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. /7 1/MQ a (.}-/ f� - / u l „// 0 ,, 0,{ Pr. y. Valuation: $ 7 i40 S-4, •-/ k P n, /0 5 /� _j/,, / Existing building area: square feet /^ e� P New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: JV ,, !Y/) 4a /4-v 74c Type of construction: Address: 1 / SO S' //I/ rr r sh . Occupancy groups: City /State /ZIP: ry„,ol o/Z 97 2 2_7 Existing: Phone: (S , 3) r y /- /7 Z 7 Fax: ( ) New: V APPLICANT 0. CONTACT PERSON NOTICE • Business name: 4illrqn ({(' a., f&( ii. p P7 All contractors and subcontractors are required to be Contact name: 7 #4,1 ,Rcla, yyC licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the . Address: /3 y 5 p s(,, if rfj),/{,,. ,,,. jurisdiction in which work is being performed. If the City /State /ZIP: �, y s 0 applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E - mail: / • • CONTRACTOR • Business name: 4jVsIr1 ( J ( f/- f- /ppir} Lie— BUILDING PERMIT FEES* . (Please refer to fee schedule) Address: / 7 e/5 ,C G,/ 0 el/10-',,, :„. . Structural plan review fee (or deposit): City /State /ZIP: 1',y a,, 6 /7 FLS plan review fee (if applicable): Phone: (5 p7) p )- /) 2 3 Fax: ( ) CCB lic.: /V 9 /'7 7� �(o Total fees due upon application: �/ �ag5�'•I� Authorized signature: !/ /� — Amount received: This permit application expires if a permit is not obtained I within 180 days after it has been accepted as complete. Print name: J.T • 1 "O /z 1, U D ate: � Z 7/e p * Fee methodology set by Tri- County Building industry Service Board. 1:\ Building \ Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB) Building Permit Application Checklist . , s . 4 FOR= OFFICE t1SE One- and Two- Family Dwelling ONLI' , x, : 1. ? .`. <:.v. z c,K,r av See Received x City of Tigard Date By:. Permit No.: q 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: 1 Phone: 503.639.4171 Fax: 503.598.1960 ' " 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑Plumbing ❑Mechanical 9'IG _ ,_ Internet: www.tigard - or.gov ❑ Other: 7 :4HE FOLLOWING ARE REQUIRED4'01 - tPLAN REVIEW, , 1,-- '., Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ osion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ bas ' protection, etc. 10 3 ' omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ . • ding codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size _ • - -t attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyrr • •1 violations exist. 11 Site /plo i plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ t ere is ore than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements an. . riveway; 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. Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, g 13 ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may 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. Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ 40 prescriptive path analysis provide specifications and calculations to engineering standards. 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 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ / architect licensed in Oregon and shall be shown to be applicable to the .ro'ect under review. - * ,�,,.,.. ..._�. • 7 sE � i a e t !. Y'. xl�T : _. I i , .r kt a4 - : TJURIS DI C 1 SP CIrICS a x 'r �= :� ''t.:-.::. � - ._y��... . ,.., ..:.. ... -.. -..• .m ^ »�,�_n1 'a�ee@ :��w. ."" :� Y -� s , ... .,. ; . Y. L " , , r. .. .S. ..� �A. 4 § - - 2 - • 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. ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 Tree List. 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 accompanied by 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, ❑ ❑ ❑ 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. 1: \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440.4613T(1 l /02 /COM/WEB) Mechanical Permit Application �?;'`� OI /c >r I:wal"s�c City of Tigard ..: eceived ; D:teB / V- tr o/ Q - Permit No.:ti75/ 9,r��.� ° 13125 SW Hall Blvd., Tigard, OR 97223 ill Phone: 503.639.4171 Fax: 503.598.1960 . i a n eview Date/By: Other Permit: l I G A IZ ��' ; Inspection Line: 503.639.41 ®� r 1 00s Date Ready /By: Juris: Ei See Page 2 for Internet: www.tigard - or.gov DEC L Notified/Method: Supplemental Information • TYPE OF WORK CITY 0 TIGAR® COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ��11 D11lS1 °4 Mechanical permit fees* are based on the value of the work ❑ New construction Addition /alteration / re 1f performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: S RESIDENTIAL EQUIPMENT / SYSTEMS FEES* g3 I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: / S'(,1, r( flM .Cr ,/" - Air conditioning co (requires site plan showing placement) 46.75 City /State /ZIP: T% � ' � ��Z z 3 - Fumace 100,000 BTU (ducts /vents) 46.75 Fumace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: rj (l trA /1 (.. /-l'r / Duct work / 23.32 7,.. 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 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 _ Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 Aid/W°1'' Gas fireplace 33.39 P A4r - /cam, ' 4( 7/ 1,01 Flue vent for water eater or gas /P c614, // / JO/7 a� fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney/liner /flue /vent 23.32 PIPROPERTY OWNER ❑ TENANT Other: 23.32 Name: 70/lap /ark-C ill Environmental exhaust and ventilation Address: A Range hood/other kitchen � /95- 5 (/' t-.. ,i.: equipment 33.39 City /State /"ZIP: 7 y ,,./ Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (501 ) ' — 13 27 Fax: ( ) toilet compartments, utility rooms) 23.32 .APPLICANT ❑ - CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel t m Pp g Contact name: S 514.15 for first four; 54.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: 0 („./71..</, Clothes dryer (gas) Other Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal 23, - 37- Minimum permit fee ($90.00) id, , vs Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12 %ofpermit fee) ID t TOTAL PERMIT FEE /00, f This permit application expires if a permit is not obtained within 180 Authorized signature: y days after it has been accepted as complete. Print name: .7G/Y�t 4h /raj �I V /I Date: * Fee methodology set by Tri- County Building Industry Service Board 1:\Building\Permits'NEC- PermitApp.doc 10/01/09 440- 4617T(11/02/COWWEB) 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. 1: \Building\Permits\MEC- PermitApp.doc 10/01/09 2 Electrical Permit Application I OR of n i.: lvsl: ONLY City of Tigard CE IV ED Received [ Date B : I g 09 , � Permit No.:, 5 � �� � 13125 SW Hall Blvd., Tigard, OR 972 C Plan Review Phone: 503.639.4171 Fax: 503.598. DateB : Other Permit: I i ,u, i ; Inspection Line: 503.639.417 20 09 Date Ready/By: :furls: ® See Page 2 for Internet: www.tigard or.gov DEC 0 Notified/Method: Supplemental Information TYPE OF WOB OF TIGARD PLAN REVIEW ❑ New construction Addition/altera ■ i I001VISIt)N Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. �. ' Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural /: I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", 100HP or more. occupancy. Job no.: Job site address: /7y s St:✓ e r -el �� � 0 Six or more residential units. 0 Recreational vehicle parks. City/State /ZIP: 7 i ❑ Health -care facilities. ❑ Supply voltage for more than �� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total I " New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 67.84 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 4 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: ,0 ,, /q� /-.4 r f' 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Sl Over 1,000 amps or volts 552.26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: (5 ) 'c'/ /1 z 7 Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchan e, actor ng to ORS 447, 449, 670, and 701.. 401 amps to 599 amps 168.54 2 / Branch circuits - new, alteration, or extension, per panel Owner signature: //ss //- Date: � 7/6), A. Fee for branch circuits with ❑ i�PPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 56.18 l 2 S��e first branch circuit Address: Each add'l branch circuit 7.42 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular _ dwelling, s�rvice and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Signal circuit(s) or limited - �(/ ", r energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: ‘-3(c. (3j Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): ( . 74 Authorized signature: TOTAL PERMIT FEE: t , g This permit application expires it a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(1I/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIALrWORK ONLY.;,. Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 --- ' " • F'11 IT . 11111 iMiiiiit4f$10 ! 2 1 11 )14 Oh g el_13 4 i belp lithirit ; 11174i°1 - 4 1 ! i I I ,t,111 1, 4,.lial - E ill 8 A it 8 /1 gP Fig ta I" ii Iiii ll 8eAd= kid 6 4 4 66 1 nr 1 41 lio,gi 0 I al i II! p Al I. MO IA; t,! 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I- 11" fi 'Uri' so i iffld Q 1 I - cc, lit l 1 il ... , . — CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: 1-- 9.4.e5q— PLANNING DIVISION: Required Setbasks: L'E' Approved 0 Not APProt eo Sick 3 Street Side ro:)1 Garaw. R cAr. : No Appro%;:(1 6 e1"-"-r L • -.:,t,iiiitin, Bwd P-o-fLiAti)9 Service Provid::,=:- 0 No lyct!ived ,fiL or/ ( 6 ENGINEERIN6 DEPARI MEN"! : Actual S pe: % AppNved 0 Not Approved Site Pla &Approved 0 N t7.62roved By: Date: 0 04 7 Notes: a CITY OF TIGARD - SITE PLAN REVIEW ILDING PERMIT NO: Approved 0 Not Approved Street Trees: 0' Approved 0 ot proved Protected Trees; ; Date: i'4 ' NOM C EV ED © 12/17/2009 09:41 5035980554 THE MANAGEMENT R P PAGE 01 El DEC 2 2 2009 0 o CITY OF TIGARD I Clean Vdab ►r Services File Number DEC 1 7 2009 u CcanWat€ S erv i ces aojoa By - salve Area. Pre- Screening Site Assessment 1. Jurisdiction: 0 /1 Dr / ' 2. Property Information (example A 111S234AB01400) 3. Owner Inf+�ati P Tax lot ID(s): ' �� i%� 1212 1 Name; J v 4'I l 4 v Company: '- (/ ' Address: /3 . Y52 `�� f,'7...% Site Address: /7K 0 � _C Iiv (CeJM -cr City, State, Zip; 73y L - Z.? f 7? ,- City. Slate, Zip: 7 y t*(, (4 /c f7 2 7-j._ - Phone /Fax: % F `el 3 c Nearest Cross Street: nedood E -Mail: ^ . 2 °' ra 4. Development Activity (check ell Thal apply) 5, Applicantt l x Addition to Single Family Residence (rooms, deck, garage) Name: J O fires AEC AEC A ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: S6r'/9 e Q Residential Subdivision L7 Commercial Subdivision City, State, Zip; Q Single Lot Commercial Q Multi Lot Commercial Other Phone /Fax: E -Mail: , 6. Will the project involve any off -site work? ❑ Yes rNo 0 Unknown .3 Vet xl 6 1, J / Location and description of off -site work 7, Additional comments or Information that may be needed to understand your project This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits. Site Development Permits, DEQ 1200•C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal Itsw. By signing This form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services heve authority to enter the project site al all reasonable times for the purpose of Inspecting project site conditions and gathering Information related to the project site. I certify that I am familiar with the Innt ration co ; lained In This doc eenl and to the best of my knowledge and belief, thi information is Inie, co ' plete, and accurate, Print/Type Name d Or i' / I Rrk Print/Type Title 0 / 1 / 40 4 4/// (m ro ,- Signature �L i � - - -4 - _ Date ZIL�y O / -- FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural RE'sources Assessment Report may also be required. ased on review of the submitted materials and best available information Sensitive areas do not appear lo exist on site o• within 200' of the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect wafer quality sensitive area if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07.20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, State, and federal law. . LJ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive areats) found near the site. This Sensitive Area Pre- Screening She Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1 All required permits and approvals must be obtained end completed under applicable local, slate and federal law. ❑ This Service Provider Letter is not valid unless CWS approved slte plants) are attached. ❑ The proposed acii i • does not meet the d iti• • develop�•�nt or the lot was platted after 9/9195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROV i E - 'LETTER IS REOU(D, / 1 Reviewed by e %� - /" C Date , — 7 ' - f� 1 ..4 , :e.$v$ :{t ,, ., , .' rrlr...P N. l+...:�iitim `...4kr °. P' . Cl n`'; k rI, "'�" r. ,,,: +,l t`I c* ^ f`t -., 1 " `a :;,'u`� * .r . , - 4 - v ,: l , 25.50 SW Hdlcboro Highway Hill ^boroVOirgon 97123 .t'�` v ., 4 ; Phone (s03 681;510(p -p" � (5n3) 681 44' i i ■ . uww rlpan Prv 'ai,,P.ga�ci4`•A1. :t. ::inA I:,i',;,i .,,.k .w..,. . ...d_ .._r_.. k.. ;r: l�fn„ r.S>''u �i...F4',r.a.\¢;;.o- 747- 2 ' ''�ji.`'6.' i1 :4".".i.:72 .WZv!R� . .:i:. ..,..P r ; ^. r+. a.'rs''''lli (,.., "" R ECENFr P Property Owner Statement p Y o EC � Regarding Construction Responsibilities ® 8 2009 Oregon Law requires residential construction permit applicants who are not licensed •F /GARD Construction Contractors Board to sign the following statement before a building perms I - D/1/40,,, issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: 4 r. (oar// //7/T e Name CCB# Expiration Date Fl I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. x /-0(144 /ar Print Name of Permit Applicant / Sign e of Permit Applicant Date Permit #: He2 x2 40 i- OOo2. S I 3'/ o Address: � ������ ��• Issue ate: D E This Copy for Permit Offices Mechanical Permit Applicatio r• l� lc►: us►c ONLY iur City of Tigard TECE Reeve FoR o a • • 13125 SW Hall Blvd., Tigard, OR 97223 �� •�• -� ;� C Plan Review 11 Phone: 503.639.4171 Fax: 503.598.1960 JAN 0 8 2010 Date/By: Other Permit: r 1 c n K D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard CITY OF TIGARD Notified/Method: Supplemental Information TYPE OF WILDING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ['New construction Addition teratio e placement Mechanical permit fees* are based on the value of the work 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-family dwelling Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling X Job site address: 1 c �- (� (4' �Ir' d� Air conditioning /� 7 J (requires site plan showing placement) 46.75 City/State/ZIP: 7`-), a , ,/ 0/e 97Z2 Furnace 100 BTU (d ucts/venu) 46.75 Furnace 100,000+ BTU ( ducts /ve nts) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work , 23.32 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 33.39 ` r ` c'v C n %o,t_ 5 line -cQ r Flue vent for water heater or gas fireplace 23.32 Q Vet Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 33.39 City/State/ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name: Fuel pipin Contact name: 14ijor first four; $4.03 for each additional Address: Furnace, etc. 1 Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) I Fax: : ( ) Water heater Fireplace E -mail: Range / ONTRACTOR Barbecue Business name: / QGf Ir q`/(e a (owl Clothes dryer (gas) ( J � � Other: Address: /3 irk Si✓ C," e f/ - c2 MECHANICAL PERMIT FEES* City/State /ZIP: `7`, r� 6 /t Subtotal Phone: ($ Z `9/- / 3 Z 3 Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: / 1/ 7/ 7 State surcharge (12% of permit fee) 0 TOTAL PERMIT FEE {Q; \ _ Authorized signature: This p ermit application expires if a permit is not obtained within 180 days after it has been accepted as complete. J . -- p ate: / /b • Fee methodology set by Tri -County Building Industry Service Board I:1Building\Permits . C PermitApp.doc 10/01/09 440- 4617r(I1 /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:\Building\Permits\MEC- PermitApp.doc 10/01/09 2