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Permit ciTy TIGARD MASTER PERMIT PERMIT #: MST2006 -00220 hi lt? :' DEVELOPMENT SERVICES DATE ISSUED: 8/17/2006 =-'-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 110BC - 08000 SITE ADDRESS: 12438 SW ASPEN RIDGE DR ZONING: R -7 SUBDIVISION: THORNWOOD LOT: 051 JURISDICTION: TIG Project Description: Partically converted basement to habitable space. BUILDING REISSUE: CUSTSOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: st BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: TRURO: sf RIGHT: VALUE: 41,404.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 st 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: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: 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 : PLAN REVIEW SECTION Reconnect only: > 600 V NOMINAL: CLS ARENSPC OCC: >=4 RES UNITS: SVCIFDR> =225 A.: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other GARY STONG OWNER applicable laws. All work will be done in accordance with approved 12438 SW ASPEN RIDGE DR. plans. This permit will expire if work is not started within 180 days TIGARD, OR 97224 of issuance, or 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 Phone: 503 670 - 7225 Contact #: of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Reg #: TOTAL FEES: $ 788.98 REQUIRED ITEMS AND REPORTS 04 Issued By : fi; /L� C f� Permittee Signature : r -=-� LW 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. C ITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00220 U .I DEVELOPMENT SERVICES DATE ISSUED: 8/17/2006 - I I ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2 S 110 B C -08000 SITE ADDRESS: 12438 SW ASPEN RIDGE DR • ZONING: R -7 SUBDIVISION: THORNWOOD LOT: 051 JURISDICTION: TIG Project Description: Partically converted basement to habitable space. BUILDING REISSUE: CUSTSOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: at BASEMENT: at LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: at GARAGE: at FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: at RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 at 4104.00 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: BOIL/CMP < SHP: VENT FANS: CLOTHES DRYER: FURN > -100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FCEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC/FDR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAUPANEL IN PLANT: MANU HM/SVCIFDR: 601 • 1000 amp: 601«amps•1000v: MINOR LABEL P 1000• amp/volt PLAN REVIEW SECTION Reconnect only: a-4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC. ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL ' AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: 1 1 iii BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE 3PENER: CL• • INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATOMM N - E CALLS: TOTAL ti SYSTEMS: Pia This permit is subject to th- regulations contained in the Tigard Owner: Contra. or: Municipal Code, State of 0 Specialty Codes and all other GARY STONG OW R applicable laws. All work will •e done in accordance with approved 12438 CW ASPEN RIDGE DR. 1.+ t$ plans. This permit will expire , work is not started within 160 days TIGARD, OR 97224 ,w pi ;�'',.:.,r ` .. of issuance, or if the work is s spended for more than 180 days. ' "' 4 iTTENTION: Oregon law req ires you to follow rules adopted by /: : : - 4 7 , • the Oregon Utility Notification / enter. Those rules are set fedh in 0 OAR 952 -001 -0010 through 9%2-001-0080. You may obtain copies Phone: 503-670-7225 C„ or 1 -800- 332 -23questi• s to OUNC by calling 503- 246 -6699 IA_ y 44. TOTAL FEES: $ 788.98 REQUIRED ITEMS AND REPORTS Issued By : /( 4 i , \\N\ ^ ., Permlttee Signature : "r �� _ ! � ,_ 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 t,ntii completion of the project. Approved plans are required on the job site at the time of each inspection. Inspections Required for: MST2006 -00220 I Code I Inspection Description I PASS Date I By MST - Master Permit 405 Excavation 410 Fill 415 Grading 205 Footing 805 MFG - Structure grading/footing 210 Foundation walls 215 Footing drain 305 Plumbing underslab 105 Underground/slab cover 220 Slab 310 Crawl drain 315 Post/beam plumbing 605 Post/beam mechanical 225 Post/beam structural 230 Underfloor insulation 235 Shear walls/anchors 240 Exterior sheathing 242 Interior shear walls 245 Firewall 250 Roof nailing 255 Wtr proofing basement walls 265 Masonry 270 Reinforcing steel (rebar) 320 Plumbing rough -in 322 Shower pan 610 Gas line X 615 Mechanical rough -in 110 Temporary electrical service 115 Electrical service 120 Electrical rough -in 135 Low voltage 910 Sprinlder rough -in X 275 Framing //0te j 810 MFG- Structure set -up X 280 Insulation 330 Water service 335 Rain drain 340 Storm drain 505 Sanitary sewer 350 Septic tank 285 Drywall nailing 289 Approach/sidewalk 295 Misc. inspection: 899 MFG - Structure final 498 Grading final X 699 Mechanical final g y 3 o L 399 Plumbing final 199 Electrical final X 299 Final inspection I: \Building \Inspection Cards \Forms \MST- InspCard- Blank.doc 12/09/2005 7 CITY OF TIGARD (,/'� BUILDING DIVISION • PERMIT #: 1-. 5 ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 1 24/5 8 c5 at5e)&_ CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: � Y — i 2Af PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message j S mer, — Corrections /Comments/ Instructions: *.#— 6r73*' ' td/A /D P / (C (I,A(sva AtePpFp 1.4.1 — X 7?77 A a -I -- ..z - 7 - f5P � .c ©H/. t Y 1 LPL, oA7 /6 / af Ui( PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL C LL FOR INS ECT 0 ❑ ADDITI AL FEES ASSESSED Inspector: .1 Date r L 3 Phone #: (503) 718- eri?,64 i CITY OF TIGARD PIO- BUILDING DIVISION ' PERMIT #: a0bb...0DaD4, 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 il Inspection Requests (24 Hrs.): (503) 639 -4175 s_' °_ INSPECTION WORKSHEET FOR DATE: g/ZZ/O (p TIME: PAGE: SITE ADDRESS: M ii - 1U v h 44,0 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: 5 ' " " ZJ PHONE #: 4' 7 s CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Qescri tion ✓. Confirm # Contact # Message PolvA N Gvt 0,Leal ot &/5 Th-a441 3'i — ✓p i1 Ak � - a 0 ✓ 3� iorr Lions •mments /1 structions: 1✓7 A , / A 6'1 9 J ()Le /o 4! c r) — /.< , ...- S ,�G,6dv' �, i €3002- - LL__ k -CALL , s�,i + • 4 �� r __ _� 9 I ■' 6P'' , › A , ' 4' iLctel %; L li ' %fw " ,Z 4. 72..z' Ntf1 C4• h i/I _ � A • 6/✓ c- /, Lox /2 4- 11-,x4 Arao✓e_ 4-, 7Jp.a )C G � �Ok Co AS keg PI y ..=.... NE; 4 -7--- i :. AgCr Eet i D _ - 0838"2---1P4sw. Ecii ,�i � , ,4fo r , /ima //Y' 556. S ,1a f dl 1 r r / � �. G ' ,1 ' - ilia.• I / g 22 d.4 ❑ PASS 61 rARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL % CA • I -PECTION ADDITIONAL FEES ASSESSED Inspector: Date: yY Phone #: (503) 718 Building Permit Appl � , i k P - g r ' _ ' ( '` ;, :A, t ' .a FM R :0i I ICE Ills ONI l,j ;.p} ' . it t `` b , gib - �aa� City of Tigard p e D f 0 Permit No r V 13125 SW Hall Blvd., Tigard, OR 9722 U 2006 e "' Phone: 503.639.4171 Fax: 503.598.1 0 Date/By.. • 1 • 0 LQ t.,0 Other Permit: 51 ltil) Inspection Line: 503.639.4175 pp Date Ready/By: Jr ` ' ® See Attached Checklist for ., s:. • � Internet: www.tigard - or.gov $ ' i(., ... .1 i ' Notified/Method // Supplemental Information TYPE OF F 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 profit for the work indicated on this application. y Li 0(4 , • • CATEGORY OF CONSTRUCTION ) a O N 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ -- ❑ 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: 1243$ sw A Sr € a I Z . 'D Cre ' ---a New dwelling area: square feet City /State /ZIP: � ti Ritr I t _ 4 7 22 / Garage /carport area: square feet Suite/bldg. /apt. no.: 1 Project name: Covered porch area: square feet Cross street /directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: '1417,tmwool> C STR TE 5 Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all • equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK - work indicated on this application. Valuation: $ C 0 /Alert? •,01 VN F. Ail $ 4E. D A4E4 - 0 ,1 A P l y l L A /L A Existing building area: square feet tt New building area: square feet CA PROPERTY OWNER .. . • ❑ TENANT , ._ Number of stories: • Name: GAR iN STJNS Type of construction: Address: I -Lk{ 3 is, S W • AS ptcN Zt o&r -- og • Occupancy groups: City/State/ZIP: ' r lgAieD l oz. Z 9 Existing: Phone: (fji 3 (p70 _ 7 2:?_ j"" Fax: ( ) New: Ft APPLICANT ❑ CONTACT PERSON NOTICE Business name: 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:: ( ) Sq.-59— L/ /U $0 12-[} E -mail: rC - 35 a "7 ,0 a CONTRACTOR l� Q • Business name: - - BUILDING PERMIT FEES'' Address: (Please refer to fee schedule) - Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) ( ) FLS plan review fee (if applicable): Fax: Total fees due upon application: CCB lic.: Amount received: [horized signature: � This permit application expires if a permit is not obtained � ` within 180 days after it has been accepted as complete. nt name: SP, Date: ���1 v 6 * Fee methodology set by Tri- County Building Industry Service Board. I: \Building \Permits \BUP- RES- PermitApp.doc 03/21/06 4404613T(1 I /02/COM/WEB) • r , .. • One- and Two- Family Dwelling Building Permit Application Checklist ; y >.. ' City of Tigard � , ltecetvy Permit No.: .,, ` 1 SW Hall Blvd., Tigard, OR 97223 Date/By �I' ® Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: .+ *17 " 24- Hour Inspection Line: 503.639.4175 ❑Electrical 0 Plumbing 0 Mechanical ;in GA' =Rl) .5n i riitil Internet: www.tigard - or.gov ❑ Other. s A - ° -. �._ / ...�,. I , ;... Ir <. . H ;•- �}) r G � f f ''� / �f ^.:, y` � -. ,37i,ti`�^' r 1,c1 —,, Nit .. \' \' � . ; „ziJ l 1 1 � ; 1 t.p i?i ) C 14 . . �1 I� I - Tf � 12 � . �t � .. j JLj;� Z L I)� 7. i L. 1 �y iZ l_ ` i � _.�� 'ii" ''At'A.tis "'. —,,AN '' 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 ❑ ❑ ❑ 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 with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 1 1 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 Ore Ion and shall be shown to be . , lineable to the rro'ect under review. �°� I I ' � ZT I-E 11:451 cf"17''I , I i All L 1.y !.,,,*:t ` l f;. 'cr w �,, g F , st y` �� u N I ..+�,i,:.r.`> .,w+Y �7 :tr. r .r ` ' 1 I a r r+ti _ A :' . ..4.2 23 Five (5) 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 tree protection measures as required by conditions 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 \BLIP- RES- PermitApp.doc 03/21/06 Mechanical Permit Application �� ` ( . " 1 tl _ ° 4 ° � , : c)1 � _ c� ,Ni �,at' ? 7�� e i ,'� � ' '1, ' :` City of Tigard Received 8 Permit No.:AAGT�M/ W z 13125 SW HaII Blvd., Tigard, OR 97223 Plan Revie / t ��./ 01Wt'/ " d Phone: 503.639.4171 Fax: 503.598.1'1 G 1. 20O Date/g ` Other Permit: Inspection Line: 503.639.4175 -"rd G A p D ate ReadyBy: El See Page 2 for z7 Internet: www.tigard- or.gov t 1_ 1 Notified/Method: I Supplemental Information . . . TYPE'"bis WORK COMMERCIAL FEE* SCHEDULE -. USE CHECKLIST. ❑ New construction 12 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: $ ® 1 - an 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ Commercial /industrial ❑ 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 Q '� /� Air conditioning or heat pump Job site address: Z Y 3 � 5/A). / s k 1`t 17t*. y /g . (requires site plan showing placement) 14.00 City /State /ZIP: -' � -. 9 , a D/2 72 2 / Furnace 100,000 BTU (ducts/vents) 14.00 / Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: r Project name: Gas heat pump 14.00 Cross street /directions to job site: Duct work 14.00 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. 10.00 • Subdivision: Lot no.: Flue /vent for any of above 10.00 r 1 N�J2p 4.),„ GS Oth 10.00 Tax map /parcel no.: Other fuel appliances ' DESCRIPTION OF WORK Water heater 10.00 n • Gas fireplace 10.00 CoN ,227 rNg LJtu Fri-- t fllteD /12 t itt ti A io Flue vent for water heater or gas • 1 - 1411 tI b /42e4 fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 .13- PROPERTY "OWNER I. ❑. TENANT Chimney /liner /flue/vent 10.00 Other: _ 10.00 Name: 694 2 I STON, Environmental exhaust and ventilation / Range hood/other kitchen Address: 1 - 2-W '3 B SW , f4; pc- /� r tD 4e" (DR , equipment 10.00 City /State /ZIP: T 94 1, e a 0/Z 9 7 Z 2 v Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (5 1,7) (97o - 721. F a x : ( ) toilet compartments, utility rooms) 6.80 F APPLICANT El CONTACT PERSON Attic/crawlspace fins 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 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 E -mail: Range CONTRACTOR - Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* • City /State /ZIP: Subtotal Minimum permit fee ($72.50) 7 a, 1 5 - O Phone: ( ) Fax:( ) Plan review (25% of permit fee) CCB lic.: , State surcharge (8% of permit fee) 5 . ‘ U ad i �� I _ - i TOTAL PERMIT FEE thorized signature: This permit application expires it a permit is not obtained within 180 days after it has been accepted as complete. Pi t name: viz C b , te: ! _ I • Fee methodology set by Tri- County Building Industry Service Board 11Building\Permits\M Perm i/06/06 1 440 617T( /� /2/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:\Building\Permits\MEC- PermitApp.doc 12/30/05 2 -