Permit il„„„ _ "' / C P ' MASTER PERMIT
. .
-'`
PERMIT #: MST2008 -00109
- ° COMMUNITY DEVELOPMENT DATE ISSUED: 7/30/2008
,T1GARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114BD
SITE ADDRESS: 09545 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 077 JURISDICTION: TIG
PROJECT: MICKAELSON
Project Description: Construct 400 sq. ft. habitable area above garage.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 400 at GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 TM RD: sf RIGHT:
VALUE: 0.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 400 41 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: 1
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 ants: WSVC OR FOR PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp 201 - 400 amp 1st WIO SVC/FDR 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp EAADDLBR CR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601.anps- 1000v: MINOR LABEL:
1000* amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS ARENSPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
NELS MICKAELSON OWNER laws. All work will be done in accordance with approved plans. This
9545 SW RIVERWOOD LN permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97224 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952 -001 -0080. You may obtain copies of these rules or direct
Phone: 503 - 598 - 9636 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 840.51
REQUIRED ITEMS AND REPORTS
Issued T ��j �( ■ _� Al! / Permittee Signatu� _ •." e i
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day. /
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/ E - /ice n ,9- eL�- T/a /c/9 /05' 44
4 CITY OF TIGARD MASTER PERMIT
III - 11 COMMUNITY DEVELOPMENT Permit a: MST2008-00109
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/30/2008
Parcel: 2S114BD03700
Jurisdiction: TIG
Site address: 9545 SW RIVERWOOD LN
Subdivision: Lot:
Project: MICKAELSON
Project Description: Construct 400 sq. ft. habitable area above garage. 9/16/09: ADD (1) 200 amp service and (10)
branch circuits.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left Parking Spaces:
Height: Bathrooms: Second: 400 sf Garage: sf Front: Smoke
Dwelling Units: 1 Third: sf Right: Detectors: Yes
Total: sf Value: $7,468.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: 1 Laundry Trays: Rain Drain: Catch Basins:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers: 1
Heat Pump: N Hoods: Other Units:
Fum <100K: Vents: Woodstoves: Gas Outlets:
Fum > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 -200 amp: 1 0-200 amp: W/ Svc or Fdr: 10
Ea add'I 500 sf: 20 1-400 amp: 201 -400 amp: 1st W/O SvclFdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'I Br Cir:
601 -1000 amp: 601 +amp- 1000v: .
1000 +amp /volt:
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)
NELS MICKAELSON
9545 SW RIVERWOOD LN
TIGARD, OR 97224
PHONE: 503- 598 -9636 PHONE:
FAX:
Total Fees: $1,004.93 •
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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th j rules - -r •rth in OAR
952- 001 -0010 throug • OAR 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.24 • - 9 o +:'.332.2
/ '
Issued By: t/ Amara" A ir = _ Perm ittee Signature: -
----.."--:°111::110---
tti >µ ;: a CITY O 1 I,. 0A D _ MASTER PERMIT
PERMIT #: MST2008 -00109
4sr
COMMUNITY DEVELOPMENT DATE ISSUED: 7/30/2008
• T/tCAK 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
"' PARCEL: 2S114BD -03700
SITE ADDRESS: 09545 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 077 JURISDICTION: TIG
PROJECT: MICKAELSON
Project Description: Construct 400 sq. ft. storage area above garage.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: - sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 400 sf GARAGE: 5f FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3. BDRM: BATH: TOTAL: 400 51 7,468.00 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
,ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS +y
1000 SF OR LESS: 0 • 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTIONS
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR:
O
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt : o
PLAN REVIEW SECTION 2
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: 1
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL O
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: . INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: O
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
NELS MICKAELSON OWNER laws. All work will be done in accordance with approved plans. This
9545 SW RIVERWOOD LN permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97224 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503 -598 -9636 Contact #: questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
Reg #:
TOTAL FEES: $ 278.11
REQUIRED ITEMS AND REPORTS
G r G�
Issued By : ��_ Permittee Signatur . ��
c
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
95 L( 5 SC )
Building, Permit Application �'� `
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Date /Bv: QOS Permit No.: 57:949 . ��la
III
° 13125 SW Hall Blvd., Tigard, OR 97223 p Plan Review
C Phone: 503.639.4171 Fax: 503.598.196d UL 2 1 2008 Date /B : • v • O r , Other Permit:
T 1 G A R D inspection Line: 503.639 Date Ready /By: ®See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 7 , , i.. Supplemental Information
TYPE NOM DIVISION 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
O Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling I=1 Commercial /industrial Valuation: $ 7 4/6
El 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: 9545 SW Riverwood Ln New dwelling area: square feet
City/State /ZIP: Tigard, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Mickaelson Garage storage Covered porch area: square feet
Cross street/directions to job site: SW Copper Creek/Sw Riverwood Ln Deck area: square feet
Other structure area: 0 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Copper Creek No 3 Lot no.: 77 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S114BD03700 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.
Build in Storage /Floor level into existing 2 story garage Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Nels Mickaelson Type of construction:
Address: 9545 SW riverwood Ln Occupancy groups:
City/State /ZIP: Tigard, OR 97224 Existing:
Phone: (503)8468039 Fax: ( ) New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Same as Above 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 /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax: : ( )
E -mail: nels.m @verizon.net
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule) ��
City/State /ZIP: 6(..)--jFax: Structural plan review fee (or deposit): g2 . Phone: ( ) ( ) FLS plan review fee (if applicable):
Total fees due upon application: /n
CCB lic.: # O Q a 1(p
Amount received: p
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: }, 6 L 5 > t,14 ,a,L t S o tit _ Date: - ( 2,1 t zo 0 8 * 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)
Electrical Permit A I t 11C, a 0 t FOR OFFICE USE..ONLY _,
l�1 , . ` �y to _ .! . �. - .r, - st
III City of Tigard i ~ " - ~- h Date /Bya 1 a ' Permit No.: OO / p0(61
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.4171 Fax: 503.598. 9* 21 2 008 Date /By: Other Permit:
T I
G A It D Inspection Line: 503.639.4175 Date Ready /By: Juris ® See Page 2 for
Internet: www.tigard- or.gov Y OF TIGAR ® Notified/Method: J7iG Supplemental Information
TYPE CITY G D1VISiO p, 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 of 75 KVA or
❑ Emergency system. larger separately derived system.
. JOB SITE INFORMATION AND LOCATION . ❑ Addition of new motor load of ❑ `A", "E ", I -2 ", °I -3 ",
100
HP no.: Job site address: ' " c LI C St,-) SL3 ` J` �s.�00D (- � R
f or o o a residential occupancy.
(
u ❑ Six or more residential units. ❑ R ecreatio
nal vehicle parks.
City /State /ZIP: 1 1 G Plit-D 0 a C1 Z Z• l ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: k., rc c pt 1- n0 y i N C. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCRIPTION OF WORK • (with above sq. ft.)
Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
,,,,,(( 200 amps or less 80.30 2
(1<I, PROPERTY OWNER - ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: t.i (_•LS 1-L- rCiLta ;(_,S 601 amps to 1,000 amps 240.60 2
Address: qs c S (,., lZ 1' of ) IZ b.JOO b Lg.) Over 1,000 amps or volts 454.65 2
Cit}' /State /ZIP: G �p I O -t 1 2-`1 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (s: , 5 li i G, ' G Fax: ( ) 200 amps or less 66.85 1
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, leas . t, t ••* a e... •"ordin • • IRS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: ,. - Date: 7(21 i Z.,608' A. Fee for branch circuits with
. ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits 4..k-
Contact name: without service or feeder fee, 46.85 first branch circuit 1'
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
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
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: (, , ` v / extension. Describe: Page 2 2
City /State /ZIP: W Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (l hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: ,�`c_ TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: 0 F: L$ r..r L 1C- t41f-c -S,,J Date: 1 2 1 Zoo f� days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: \Building\Permits\ELC- Permit App.doc 05/23/06 440- 4615T(11/05 /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*
❑ B urglar Alarm
Fl G • arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
`- COMMERC ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ I nstrumentation
n I • ntercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O utdoor 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 03/23/06
•
• . . . Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be 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 and complete the following statement:
1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X 1 will be performing work on property 1 own, a residence that 1 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, 1 will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
0 EL5 v~Sc-\6v1 -Ei -5 6k0
Print name of permit applicant Signature of permit applicant
7 1301 1_00
Date
Permit #: ,r /- - CX2/19j
This form is supplied to building .F qS uz ��i,Ptiw
permit offices by the Oregon . L 7.*„ Address: 5
Construction Contractors Board, N`:.**;:� 14 ,:
as required by ORS 701.055 (6) * �,a . Uie 97 �
Issued by: /T Date: 7,,0/c15
This copy to issuing permit office
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.
ipi BUILDING DIVISION
' `' :,' ¢ fr TRANSMITTAL LETTE
T ri �A��R +Dti
' »Yip?
TO: 4 C , k riX �� DATE , VE
DEPT: BUILDING DIVISION CEIVED
Nov 2 0 2006
CITY OF TIGARD
FROM: O LS �iGv�
I, � S0 ; BUIL ' �GDIVISION
COMPANY:
PHONE: eo 3 96, F L- S a 3 ; .I I "'ELI
By/
RE: ct S ,s c.,) rz.. u ,4 o i I\ IrJ c2OO ooiO9
(Site dress) / ((Permit/Case Number)
Project name or subdivision name and lo. . ber)
ATTACH D ARE THE FOLLOWING I.
Copies: Description: Copi . s: Description:
A dditional set(s) of plans. 1 Revisions: 0r htF- e. D u 2vrC TO L-
Cross section(s) and details. Wall bracing and/or lateral analysis. S PEE_
Floor /roof framing. / Basement and retaining walls.
Beam calcul.' ' • s. 7 ------- Engineer's calculations.
Other (explain ` .
REMARK . . V71 / U /l n (Ji Yuj ` ?2r r..
bra r► / 3 ,----P7 p S
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: t . 2 (ۥ o% Initials:
Fees Due: ❑ Yes ❑ No Fee Descr ption: Amount Due:
36,00 \ T/i . $ i) . OQ
Me*. $ ?7 .56
M $ 76
p $ 7
Special 5 ta 2 -46
Instructions:
Reprint Permit (per PE): t .Yes ❑ No ❑ Done
Applicant Notified: Date: 1 1 • 2 (e,.0 sii Initials:
I:\ Building\ Forms \TransmittalLetter- Revisions.doc 4 /4/07
Plumbing Permit Application
Building Fixtures ::
' . FOR OFFICE USE ONLY -
-: Cl of Tigard Received Permit No.:
q 131 SW Hall Blvd., Tigard, OR 97223 Date/By: •M� �a //Q� liq C Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Date I C A R D Inspection Line: 503.639.4175 Date Ready /By: .11.5.4- ® See Page 1 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
• TYPE OF WORK • - • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . . • SFR (I) bath 249.20
❑ i - 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: C S L(S ST •Af y- q(-, r ) 0 cl Lc) Catch basin or area drain 16.60
City /State /ZIP: Lt G(/t✓L1 i 0 (2- q 2.7-- 7 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:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
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
Backwater valve 16.60
Clothes washer / 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
_ Ejectors /sump 16.60
Name: IJ't; k_ ( ( 7‘,. ‘. 1.7. C ((_0-r_L. C"C ,--, Expansion tank 16.60
Address: 9 S S .,,J ft 4 /2 lC1 c1 (_ N ) Fixture /sewer cap 16.60
City /State /ZIP: jI,*f ` b i U 0 (7Z. 2 '+ Floor drain/floor sink/hub 16.60
Phone: (: ;- Q c Garbage disposal 16.60
�G� .� t .• c Cc% � � Fax: ( )
0' APPLICANT . . ❑ CONTACT PERSON. Hose bib 16.60
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 • Water closet 16.60
Business name: / Water heater 16.60
Address: Other:
City /State /ZIP: 0 Subtotal
Minimum permit fee: $72.50 0.)/'-)
Phone: ( ) F ax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: • Plumbi 1 : ' . • o.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: �. TOTAL PERMIT FEE
Print name: pJ i�(__-S 1 j c. e ",{_,C I Date:t 1 126 /?cos 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- PermitApp.doc 12/27/06 440- 4616T(l0/02 /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 - 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 $1.52 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: $50,001.00 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:
\Building\Permits\PLM- PermitApp.doc 12/27/06
" 1 ' ,... FOR O FINE USE aild
Mechanical Permit Application - -itN L i t
_ *' City of Tigard Date/By: Permit No:MsrAf.a-ce /o7
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
^• Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
DateBy:
` Inspection Line: 503.639.4175
T 1 G ASR! D, lns p Date Ready /By: �Juris HI See Page 2 for
s1T 'a7.IF;F4?, DYn Internet: www.tigard - or.gov Notified/Method: /06 Supplemental Information
. 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling • Air conditioning or heat pump
Job site address: ° 1 59 S S t' (? 1- ■-I E,n ) 0 c (...._t--
(requires site plan showing placement) 14.00
City/State/ZIP: - Fumace 100,000 BTU (ducts /vents) 14.00
y /State /ZIP: 1S��W�� r v�? `�� � '7 �_y
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 1 10.00
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
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
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 I ❑ TENANT Chimney /liner /flue /vent 10.00
_ Other: 10.00
Name: i-- LS ii v\ L p Environmental exhaust and ventilation
_ Range hood/other kitchen
Address: GI ¶L-(S — (Ll `/ akJJ L /j equipment 10.00
City /State /ZIP: 56� W ( ) 6 (7 `i ' 2_2_1 Clothes dryer exhaust / 10.00
/ Single -duct exhaust (bathrooms,
Phone: (S) j) S-'/S" 9 (03 (o Fax: ( ) toilet compartments, utility rooms) / _ 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00 _
Business name: Fuel i ro
PP g
Contact name: $5.40 for first four; $1.00 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:
Clothes dryer (gas)
Other:
1 :
Address: / I MECHANICAL PERMIT FEES* , '
City /State /ZIP: ��f Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax:( )
Plan review (25% of permit fee)
CCB lic.: / --' State surcharge (12% of permit fee)
' TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: > /� days after it has been accepted as complete.
Print name: 1,\ r L S v-., ;-(.- twtaE)t r J Date: (I / (ZQQ' * Fee methodology set by Tri- County Building Industry Service Board
I :\ Building )Permits\MEC- PermitApp.doc 01 /19/07 440- 46I7T (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.
I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2