Permit CITY OF TIGARD
MASTER PERMIT
Ill
. : a:_`::_ COMMUNITY DEVELOPMENT Permit #: MST2009 -00092
T_1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/15/2009
Parcel: 1 S 125CA06900
Jurisdiction: Tigard
Site address: 7440 SW TAYLORS FERRY RD
Subdivision: Lot: 0
Project:
Project Description: Addition of 222 square feet. .
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:
Total: sf Value: $0.00 Rear: 0
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 Drains: 0 Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: Vent Fans: 0 Clothes Dryers: 0
Heat Pump: Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =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: 0 401 -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: HVAC: Security Alarm: Vaccuum System: Garage Opener: All
Other: Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
PERONT, ALLEN B & ANN P OWNER
7440 SW TAYLORS FERRY RD
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $384.95
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. At work
will be done in accordance with approved plans. This permit wit 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 thro ggh 952- 001 - 0100. You may obtain a of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ti 1C 0 •___,-)_(: A X / � ) Permittee Signature: - '+�-
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
941,3 t t\S":"°,)
BUILDING DIVISION
i o
TIGARD TRANSMITTAL LETTER
3
TO: Dan DATE RECEIVED:
DEPT: BUILDING DIVISION ." :r
.iii 1 2 2009
FROM: Allen Peront -- - ITYOFTIGARD
UILDING DIVISION
COMPANY: Self
PHONE: 503- 452 -8707 By:
RE: 7440 SW Taylors Ferry d MST200900092
(Site Address) (Permit /Case Number)
(Project name or subdivision nam and lot number
ATTACHED ARE THE FOLLOWING I S:
Copies: Description: opies: Description:
Additional set(s) of plans. Revisions: Ver 1.3
4 Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
2 Beam calculations. Engineer's calculations.
2 Other (explain): Rear Elevations
REMARKS: Increased Glulam beam to 6.75 X 13.5, removed center support post.
Added MTSA straps to tie brace panel, angled walls and existing wall together.
Changed Gluelam support post to attach to top of 12" round cement post/pad structure so there is no post
in the ground. Added 1.5 X 3 window in wall under Glulam.
' ° FOR OFFI E U ONLY . . .
Routed to Permit lnician: Date: ( P_ O9 Initials � 0
Fees Due: es I I No Fee Description: Amou ue:
-DT) L P �( $ -2,
$
$
Special
Instructions:
Reprint Permit (per PE): Yes a • o n Done
Applicant Notified: Date: sic ( 'r(0 7 Initi 1 j
I: \l3uilding\ Forms \IransmittalLet ter - Revisions.doc 4/4/07
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
BUILDING DIVISION
a
TIGARD` TRANSMITTAL LETTER
TO: L9Ct f'✓ DATE RECEIVED:
DEPT: BUILDING DIVISION
REr
FROM: Allen Peront JUL 0 D
COMPANY: Self OITY OF G DIVISION
PHONE: 503- 452 -8707
BUI IN By:
RE: 7440 SW Taylors Ferry Rd MST200900092
(Site Address) (Permit/Case Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Co ies: Desci i tion:
2 Additional set(s) of plans. 2 Revisions: Ver 1.1
2 Cross section(s) and details. Wall bracing and /or lateral analysis.
2 Floor /roof framing. Basement and retaining walls.
2 Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: Incresed size of stub out wall from 3' to 5' to increase addition to 102.5 sq. ft. Corrected
foundation plan to correct stem wall height, added footing dimensions, anchor bolt installation and wall
holdowns per red line corrections. Moved center support column 3' -8" East, clarifed column footing
depth, increased ledger SDS length, and included red line notes in Rear Elevation. Increased Gluelam
size along with column cap, base to increase strength.
FOR OFFICE:• USE ONLY ' >> ..q�
Routed to Permit Technician: Date: Initials:
Fees Due: I Yes No Fee Description: Amount Due:
,:y < c s 4
Special
Instructions:
Reprint Permit (per PE): 1 Yes I I No Done
Applicant Notified: Date: Initials:
I: \Building \Forms \Transmittal Letter- Revisions . doc 4/4/07
Building Permit Application
a �
Residential 4 I �' D FOR OFFICE USE ONLY
11 14 _
t
R eceived
- City of Tigard 2 009 j Permit No. 4 ,.. co -.
APR 15 Date /By
13125 SW ball l3hd., "hieard. OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: q '/5=09 aJ$,9 Other Permit:
Inspection Line: 503.639.4175 ^^ ^fie Ct: 1 I`w'1 Date Read �n� e 2 for
TIGARD p 4�I : 1 �+ j r Ready/By: El See Page
Internet: www.11gard- or.gov j�, t 1 d,, \'O 'ONION Notified /Method: � Cl Supplemental Information
a U d a7i IH
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
® Addition /alteration /replacement ['Other: equipment, materials. labor, overhead. and the pr fit fbr the
CATEGORY OF CONSTRUCTION
work indicated on this application. 3j
Valuation: S / • J / , b
® 1- and 2- familydwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
Ill Master builder El Other:
Number of bathrooms:
,1OB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7440 SW Taylors Ferry Rd New dwelling area: 88.5 square feet
City /State /ZIP: Tigard, OR, 97223 Garage /carport area: square feet
Suite /bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 74 Ave. Deck area: 271.5 square feet
Flag lot behind 7480. Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based 011 the value oldie work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: IS125CA -6900 #2 equipment. materials, labor. overhead. and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Covered patio and extension of kitchen into the patio. Valuation: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Nance: Alien & Ann Peront Type of construction:
Address: 7440 SW Taylors Ferry Rd Occupancy groups:
City /State /ZIP: Tigard, OR, 97223 Existing:
Phone: (503)452 - 8707 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Property Owner All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /LIP:
applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
CONTRACTOR
lusiness name: Property Owner BUILDING PERMIT FEES*
Address:
(Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
!'hone: ( ) Fax: ( )
Total fees due upon application: 18r?. 35
CCB lic.:
Amount received:
Authorized signature: Lk - "et ,"---- � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: A l it e; ,f p r - 0 N Date: * Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(I I /02 /COM /WEB) ;8L1/4, Q 5
Building Permit Application Checklist
One- and Two-Family �wellin t` ' �v' p i tram
�' g * ti , ¢ef s S r-thofOR. OF FICE _ $USE ; sONLY ; rp a i� ;
.fl rIli °h ga3.3.`tIpla it : M it " s' r n is
dl. ietigl Received
9s. C of Tigard
r ' '" Date /fay: Permit No
".a`' "q 13125 SW 1-lall Blvd.. Tigard, OR 97223
r - y; .. Phone: 503.639.4171 Fax: 503.598.1960 Associated permits
c-- ii -' .4 24 - Hour Inspection Line: 503 639.4175 ❑Electrical ❑Plumbing 0 Mechanical
Tt GARD
t p.os .: li Internet: www.tigard- or.gov ❑ Other
i , „�T�H iftikkO W,+ siewTEMS ARE,in ttivi Fazio N itvi ww457 , ; ; wgmisi tgui
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
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 El ❑ ❑
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 ['plan ❑ 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 to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans vvith cross references between plan location and details. Plan review cannot he completed if
copyright violations exist.
11 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.
12 Foundation plan. Show dimensions. anchor bolts. any hold -downs and reinforcing pads. connection details. vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, 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. 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- ❑ ❑ ❑
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 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 project under review.
=JURISDICT NAETtSPECIFICS �j tkf} ,` s„ ; tt a {, ..f1 t �s it—Zi. APNAW S _ F -r .:. .
�! . ;� ..... v.,.,. .... : — .r..,..s..:.. ..... . X X.4.1 t.w:A tie' w . Yif t'�r!` i'' lKai k . ^.! �" t3 s1, . ' ...� -X!ta,
23 Five (5) site plans are required for Item1 1 above. Site plans must be 8-1/2 x 11 or 1 1 x 1 T . ❑ ❑ ❑
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 he 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.
I: \Building \Pernhits \RJ I'- RES- PertnitApp.doc 03/21/06 440- 4613T(1I /02 /COM / \EB)
Mechanical Permit Application• f,. - . _ - - FOR - OFFICE USE ONLY
� 3 '� v ` ': `
M:I Received - -- ,. .
City of Tigard n z ,
Date /By
° 13125 SW Hall Blvd.. Tigard. OR 972 '23 1 't Plan Review
Permit No.rn�Z�� ,(�Z Phone: 503.639.4171 Fax: 503.598.19600 R 1 Date /By: Other Permit
Inspection Line: 503.639.4175
TIGARD r Date Ready /By: Juri, ei See Page 2 for
Internet: xvw-xv.ligard- or.sov or ®1� - 0 tcp + D
Notified /Method: Supplemental Information
CC(
u D
tS!
TYPE OF V1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
CI New construction ® Addition /alteration /replacement 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
308 SITE INFORMATION AND LOCATION Heating /cooling
Job site address: 7440 SW Taylors Ferry Rd Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZI "Tigard Furnace 100.000 BTU (duets /vents) 14.00
Furnace 100 .000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: 74 ave Duct work 1 10.00 10.00
Flag lot behind 7480.
Hydronic hot water system 14.00
Residential boiler (radiator or •
hydronic) 14.00
Unit heaters (fuel -type. not electric).
in -wall, in -duct, suspended. etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: 1S125CA -6900 #2 Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Covered patio and extnesion of kitcvhen into patio to make a corner room. Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
® PROPERTY OWNER Chimney /liner /flue /vent I 10.00 10.00
❑ TENANT
Other: 10.00
Name: Allen I'eront Environmental exhaust and ventilation
Address: same Range hood /other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 1 10.00 10.00
Sinele -duct exhaust (bathrooms.
Phone: (503)452 - 8707 Fax: ( ) toilet compartments. utility rooms) 6.80
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
• Other: 10.00
Business name: Property Owner
Fuel piping
Contact name: 55.40 for first four; 51.00 for each additional
Address: Furnace. etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
-mail: Range
CONTRACTOR Barbecue
Business name: Property owner Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 72.50
Plan review (25% of permit fee) 18.12
CCI3 lie.: State surcharge (12 %ofpermit fee) 8.70
TOTAL PERMIT FEE 99.32
Cam. `.e�
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: /9- ( ( E „/ / ego N 1-" Date: * Fee methodology set by "Fri- County Building Industry Service Board
IABuildingA Penults VMEC- Permit A pp doc 01/19/07 440 - 46171' (1 I /02 /COM /WEB)
Mechanical Permit. Application - City of 'Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1: \13uilding \ Permits \MEC- PermitApp.doc 01/19/07 2
Plumbing Permit Application PErFilr-
Building Fixtures `'� - y is �� T F,ORtOFFI : USE,ON L Y ,;rs WM'
a ; �. ".7" itaiv ,.::: " .... � ...? 4.x ` F "> 1:4 , t 4 . _ .
. 7'. City of Tigard APR 15 2009 Received - Permit No.: y\A 2 " OCc2
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1 OR OF TIGARIJ Date/By: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING I '/+ / �+ Date Ready /By: Juris El See page 2 for
T •I.. nR D` i �V ILDIl�G DI V IS ILJ M Notified/Method
> Internet www.ugazd- or.gov , cT c Supplemental Information
TYPE OF .WORK FEE* . SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description 1 Qty. 1 Ea. Total
14 ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
W'- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• . JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: -7 (ctJ si '''C ;y t , 'err / Catch basin or area drain 16.60
City /State /ZIP: L (SJ� % 0R-- / c 7 ??-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 6 �G
R d Manholes 16.60
Rain drain connector 16.60
f. Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) / Page 2 5s - "---
Subdivision: I Lot no.: Water service (no. linear ft.: _ ) Page 2
Fixture or item
Tax map /parcel no.:
. Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
4cedi r tt Al 0 QL (P/S Q - at p/Qf- Backwater valve 16.60
R-00 it-t Z- 1 `l - 3o t spa OLi`v Covey Clothes washer 16.60
Dishwasher 16.60
OPERTY OWNER . " . I " " ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: /9 `( et ) ge V-cc n/
Expansion tank 16.60
Address: 7 q Lf( .J -s" YCQ2s c' Fixture /sewer cap 16.60
City /State /ZIP: 7-Igo l Ole q7 )-a-,3 Floor drain/floor sink/hub 16.60
Phone: (.52)3 S3 ) CSC- - 00 7 ? Fax: ( ) Garbage disposal 16.60
" - Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON- '• � � e � Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
'
. CONTRACTOR
W a t e r c t 16.60
Business name: (,() /, er Water heater 16.60 .
Address: Other:
City /State /ZIP:
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential back o it fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
A State surcharge (12% of permit fee)
Authorized signature: ( , „3---- TOTAL PERMIT FEE
Print name: ,C(e,t/ /Deco v d Date: fi /(57( 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 \PLMF- Permit App .doc 12/27/06 440- 4616T(10/02/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 - lit 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 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 $10,000.00 $72.50 for the first $5,000.00 and $ I.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 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 $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing , ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-4
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
1:\ Building \Permits\PLM- PermitApp.doc 12/27/06
Electrical Permit Applicationrs . FOR OFFICE USE ONLY
City of Tigard c eived Permit No.: 1 (l \Z '� 2
II
- ° 13125 SW ball Blvd.. Tigard. OR 97223 1 2009 Date /By:
APR Plan Review Other Permit:
f hone: 503.639.4171 Fax: 503.598.1960 Date /By:
Inspection Line: 503.639.4175 t" Date Read '/B Idris 0 See Page 2 for
TIGARD Internet: www.tigard- or.gov C' �Y t I V � ; < Notified /Method: Supplemental Information
BU!L D,i; - :u GI VISION
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement
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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ". "F. '1 -2 "I -3
Job no.: Job site address: 7440 SW Taylors Ferry Rd
100H or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /"LIP: Tigard, OR 97223 ❑ 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: 74 ave Description 1 Qty. 1 Fee. I Total I "
New residential single - or multi - family dwelling unit.
Flag lot behind 7480 Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: SI25CA -6900 #2 Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Covered patio and extnesion of kitcvhen into patio to make a corner room residential (with above sq. 0.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Allen Peront 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps I 240.60 2
Address: site info Over 1.000 amps or volts 1 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)452 -8707 Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease. rent, or exchange, according to ORS 447. 449. 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, er panel
Owner signature: / ' /,,.. Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
I3usiness name: Property owner B. Fee for branch circuits
without service or feeder fee. 1 46.85
Contact name: 46.85 2
first branch circuit
Address: Each add'I branch circuit I 6.65 6.65 2
Miscellaneous (service or feeder not included)
City /State /LIP: Each manufactured or modular 9090
dwelling. service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
13usiness name: Property owner Signal circuit(s) or limited -
energy panel, alteration. or
Address: extension. Describe: Page 2 2
City /State /LIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCI3 Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: Subtotal: I 53.5
Print name: Date:
Plan review (25% of permit fee): I 13.37
/� State surcharge (12% of permit fee): 6.42
Authorized signature: C(�, (i" "C � TOTAL PERMIT FEE: 79.71
This permit application expires if a permit is not obtained within 180
Print name: (( e ,e w v Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1 \{ 3uilding \PermitsV31_C- PermitApp doc 05)23/06 440 - 46151(1 I /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 ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
Other:
COMMERCIAL WORK ONLY: rr
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
Fl I-IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \k3uiIding \Permits \ELC- PermitApp.doc 03/33/06
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