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Permit 5 ,0v_/. , r a .. / . 0 A ,t. - p (ee.._4(„.. z ;w CITY OF TIGAR® MASTER PERMIT r g m COMMUNITY DEVELOPMENT Permit #: MST2008 -00015 TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/04/2010 Parcel: 2S102DCO5100 Jurisdiction: TIG Site address: 13778 SW HALCYON TER Subdivision: Lot: 1 Project: GERTZ HOMES AT EDGEWOOD Project Description: New SF. 5/12/10, adding (2) bar sinks and (1) laundry tray. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 1141 sf Basement: sf Left: 5 Parking Spaces: Height: 25 Bathrooms: 3 Second: 1433 sf Garage: 497 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $270,359.20 Rear: 15 PLUMBING Sinks: 4 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Dram: 100 Catch Basins: Lavatories: 4 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1 NAT Heat Pump: N Hoods: 1 Other Units: Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 4 Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add 500 sf: 3 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add' 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) GERTZ CONSTRUCTION CO INC THREEFOOT PLUMBING 19200 SW 46TH AVE PO BOX 274 TUALATIN, OR 97062 WEST LINN, OR 97068 PHONE: PHONE: 503- 939 -2384 FAX: 503 -650 -8212 Total Fees: $13,444.84 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 a • •ance wi .proved 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. ATT. TION: Oregon la Nrequires qu to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0.10 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by Iling 503 246.6699 or 1.800.332.204. � /� I : e =1(( Issued B • �_�� ./ �i` P erm i t tee Si gn. /?o/io ac g bed ( A/ (Nu ;± 1 ;9 CITY OF TIGARD MASTER PERMIT ` ffi COMMUNITY DEVELOPMENT Permit #: MST2008-00015 T i Gkit:0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/04/2010 Parcel: 2S102DCO5100 Jurisdiction: TIG Site address: 13778 SW HALCYON TER Subdivision: Lot: 1 Project: GERTZ HOMES AT EDGEWOOD Project Description: New SF. 5/12/10, adding (2) bar sinks and (1) laundry tray. 7/20/10 added (1) A/C unit B.T. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 1141 sf Basement: sf Left: 5 Parking Spaces: Height: 25 Bathrooms: 3 Second: 1433 sf Garage: 497 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $270,359.20 Rear 15 PLUMBING Sinks: 4 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 100 Catch Basins: Lavatories: 4 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckfiw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1 NAT Heat Pump: N Hoods: 1 Other Units: Furn <100K: 1 Vents: Woodstoves: Gas Outlets: 4 Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 3 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: 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) GERTZ CONSTRUCTION CO INC THREEFOOT PLUMBING 19200 SW 46TH AVE PO BOX 274 TUALATIN, OR 97062 WEST LINN, OR 97068 PHONE: PHONE: 503 - 939 -2384 FAX: 503 - 650 -8212 Total Fees: $13,497.20 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all othe pplicable 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 ' ,uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos ules are set forth in OAR 952- 001 -0010 through • ..- 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 3 246.669% or 1.800.: '.23. 0 „110 01111.11 -,'"-- r.— 41111111110 Issued B . —gar ....--L.11. _ --�. _ ._....-...0.. - =rmittee Signature: / 4 ,,,,:,, a CITY OF TIGARD 4 : MASTER PERMIT { t COMMUNITY DEVELOPMENT Permit #: MST2008 -00015 T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/04/2010 Parcel: 2S102DCO5100 Jurisdiction: TIG Site address: 13778 SW HALCYON TER Subdivision: Lot: Project: GERTZ HOMES AT EDGEWOOD Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 1141 sf Basement: sf Left: 5 Parking Spaces: Height: 25 Bathrooms: 3 Second: 1433 sf Garage: 497 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $270,359.20 Rear: 15 PLUMBING Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 100 Catch Basins: Lavatories: 4 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1 NAT Heat Pump: N Hoods: 1 Other Units: Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 4 Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add l 500 sf: 3 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: 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) GERTZ CONSTRUCTION CO INC THREEFOOT PLUMBING � _ 5i O 0_,,,L, � 19200 SW 46TH AVE PO BOX 274 TUALATIN, OR 97062 WEST LINN, OR 97068 PHONE: PHONE: 503 - 939 -2384 FAX: 503 - 650 -8212 Total Fees: $13,360.78 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. Tho- - rules are set forth in OAR 952 - 001 -00 rough OA 9552 -00 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80.332.2344. Issued Permittee Signature: K' A -1‘4-i--- 3 ? #c3 /5c) 7v 6 � Building Permit Ap plication . Residential �� a , 1 OR OI 1 ICL USE ON l t_ _ i . � � ' City of Tigard r i ECE1VC RI Ret vex , / / I /� ♦-- Perm No.: / — 4 1 q 13125 SW Hall Blvd., Tigard, OR 97223 FEB 2 9 Z008 Plan Review I N I. ®. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: 3 5 ?.4k 08 Other Pennine g cu T I G' R D Inspection Line: 503.639.4175 CITYOF TIGAARD Date Ready/By: Juris: ® See Page 2 for Internet www.tigard-or.gov BUl INGDIVI IVFJ Notified/Method: �j Sup lemental Info anon t ,7 . TYPE OF° WORKF q REQUIRED DATA 1, .14" +24A 'M1 y.DVI4ELLING 4. ® New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of a113,5 - ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the slr*( t _ ' r ' s r CATEGORY �O'F CONSTRUCTION . r work indicated on this application. R 359. 40 ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ( 7 46 1 4 -04 1 i ❑ Accessory building ❑ Multi- family Number of bedrooms: c/ ❑ Master builder El Other: Number of bathrooms: vo.N ,..,,r . , t� e JOB'SFTEULNFO M LOC , zJ a u s ; ' Total number of floors: 'Z Job site address: f 3 7 7 8 S 4 j � l 04 reR/L4ice New dwelling area: 7 square feet A$ 7 5 City/State /ZIP: 1 t 4Q J Q4 G ON 4 7722 3 Garage /carport area: -+ square feet 4/f Suite/bldg. /apt. no.: V Project name: � '! Covered porch area: a 6 5/ square feet Cross street/directions to job site: H, /! S'' - w 4 d N Deck area: --- square feet Cat 4. A.4 lb 6d7 [s1 a- b GL Other structure area: square feet /' REQUIRED DATA >COMIGI -FLI L- NSE .,: 1 - a 1ST' o ri Subdivision: GeR rs ar-t t w d O Lot no.: / Permit fees* are based on the value of the work performed. Tax map /parcel no Z 5 / 6 Z D e_ Q [ Indicate the value (rounded to the nearest dollar) of all „ , + equipment, materials, labor, overhead, and the profit for the ..4 q a ?. ,, ,,. , - . r ! . DESCRIPTION O F. WORif a r_. work indicated on this application. N e c.) lip e __ Valuation: $ Existing building area: square feet New building area: square feet axJ' f �,;. t( "'� �' 'k 'ir F' 1 tt 1 t T 1 c ' �; ii ."44 t j PR! r . O -, s . t { .: , rte, ;' r4r ell ; e ,' z . 4 } g. i f ? : .x ° }: "ri+ _{ Number of stories: Name: a e t_f� devca 3'1 cc c 4 ly � L � ��o aArY laic Type of construction: , Address: 17 2 60 S cJ _ 4/ C -f- 4 y e. . Occupancy groups: City/State/ZIP: re ca (et-6'A/ c' 7 704 Z - 8 ? ? e Existing: Phone: (503 ) 6, ? Z - 3 3 ? o Fax: (.re 3) C ?Z — r Y3 3 New: T (yr 8 � "4 `�,�Y� Z :f s � .N .t q , 77 � . ?; ` �., ` }, !fil . P ' .w, k'. , ,. ,f ' .. + e ® CONT PERSO , ` ... w . r { N OTICE r n M, ',;.� tr.4' • Business name: G f.Z CON s'iF'.[ f[ c i a ,y a !d a . All contractors and subcontractors are required to be Contact name: l� C ¢� licensed with the Oregon Construction Contractors Board p under ORS 701 and may be required to be licensed in the Address: ,,,z s cJ YG Av - jurisdiction in which work is being performed. If the City/ State/ZIP: 7 q �, applicant is exempt from licensing, the following reasons 4 1 D /Z 9 7OGZ'077D apply: P g, g Phone: (SG3)G f Z _ 3 3 ?O Fax:: 3) 6TZ- 5 f5 E-mail: /Ce, a �x ete7'�2, c o ,e (5/4-r h ° $ } 7'k r , � : \ .r ON i +a_(a .. f 1 ', S 1 h . Business name: L e/L L Z CAA f1 f/�LLL7 [ 0 A/ C4, 4 L . BUL 8 +:7 , g 1 U �, � h .jr Y } r 4 �t Address: / 7 4 00 S w 3 L -f4 A v e, ,. � .. l t►�I : ' w � 6 x ; . r City/State/ZIP: 'k 4 !4 . ag_ 7 , o G 2 - e 7 7 Structural plan review fee (or deposit): Q Z FLS plan review fee (if applicable): Phone: ( sa3) �o ! , Z. - 3 3 9 o Fax: (S G 9 - 5 Y.3 3 CCB lic.: 3 Y 3 5 d Total fees due upon application: Amount received: Authorized signature: ��� This permit application expires ifa permit is not obtained / within 180 days after it has been accepted as complete. Print name: L4K G ea< -fe Date: Z-2 ? -6 $- * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(1l /02/COM/WEB) Building Permit Application Checklist • One- and Two - Family Dwelling „� t4, =I r ' w r 4 ��� ,_i �r %/1'41':- /, � rolz o r l lcL ,.. 1. �I � ,— 5 , ; • W � ��F. ( . t `��; ,r. t�'Y>rvc _ . _ g r '� ..v. , . '� r`,ae � � b) TM ., e; v d �' R eceived ? '� ;,,� ;�, City o f Tigard Permit No.: IT'' "a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: 3 C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: k- -..,.;.4N ,, 24- Hour Inspection Line: 503.639.4175 ,, 0 Electrical ❑ Plumbing ❑ Mechanical 3 Internet: www.tigard- or.gov 'N'„ ;:D Other: w 444:14,Q I1I W I:N G ..t.. 1 t15., 1i 1 Okii R . 1?,ZF O R ±'I i A N R -K '' " Ce=4 : _ ' ` :;''.116's \ t l ' ,N / � r 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. Lb 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. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 1 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 -sie sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if j 1 copyright violations exist. 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. N.: 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. ❑ 0 ❑ 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. 2 0 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. 2 2 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or 0 ❑ ❑ architect licensed in Ore on and shall be shown to be a..ltcable to the .ro ect under review. ;IUR �SI'Ic }IL .r,' 4 r . .� � l �..,. .1 .��/4L F �. l"4 t ^ ""'k fj SYd i:l S .}Y .,� '�. .. i r Lk... . ry : J, . .,.vi. 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 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 :\ BuildingTennits \BUP- RES- PermitApp.doc 03/21/06 440-4613T(Il /02/COM/WEB) , Plumbing Permit Application Building Fixtures roa OFFICE' USE ONLY , . • . • City of Tigard -,, g R 0 " /� - 7 ' Pe rmit No.: IN a 13125 SW Hall Blvd., Tigard, OR 97223 ew Phone: 503.639.4171 Fax: 503.598.1960 FEB 2 9 ZO I gate/By: Other Permit No.: C /e i` Vail Inspection Line: 503.639.4175 " vim TIGARD • teR B y uns l Internet: www.tigard-or.gov I , . T� . CITY Y TY �F / � f o d• S S ee Page 2 for 1 r �41 Supplemental Information W i R ` , 5 4 7; 'TYE. OF *WORK : �} t , r t'sc. i � }'° ' �- w �,.,. � ;. "...' ,. .. ; .4 Y c.. , „. - , ,ra.: , d_7rdMBG.t�Et1 @Y��!�° • �: ... �� _._ . ? - _ _. ..� x . y w 34 ,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) H . `<CA'TEGORYOP CONSTRU FION •? •SFR (1) bath 24920 12'1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath I 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other. z ; Fire sprinkler ( sq. ft.) _ Page 2 ! x • ' � >.. - JOBuSn:tr,INFORM AND LOCATION -!.•:: ' ,' `- •,-` .;i S u ti l i t i es Job site address: / 3 7 V s 4, ,ga /< , d /1P re,„,„„ Catch basin or area drain 16.60 - City/State/ZIP: ` y a „,, 0 , e ? 7 223 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: �/ Project name: Footing dram (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: /1,41/ St Itiw f f one Manholes 16.60 if doe 4A- e 't ACC y •r t 0 0 d Rain drain connector 16.60 ACC, Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 4 eg 1f� g 4 .e s • f e 1t c c ( I Lot no.: Water service (no. linear ft.: ) Page 2 7 Fixture or item Tax map /parcel no 2 5/oz 0 c. O s Absorption valve 16.60 ' bu1 A ' a •'••:!•,•- !. . r ! ` . , ', DESCRIPTION' , r1Q . . :. ,. WORK r .:" , „ `' •"' , . ,,. r '�' , Backflow preventer Page 2 • /`(t +t! tJ llo fsf e Z. ( , s f- Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 " 1 7 ,•: . 1/QPER - tO : ' I , ®r CE ! ,,.:N ' r 4 r2 `. y Ejectors/sump 16.60 Name: G Cet,ZIL a.J s .ifA, Q., (c Q e., l v -- Expansion tank 16.60 Address: • 1 9 Z 00 SG. 4 1 1 ‘ "K / o e Fixture/sewer cap 16.60 City/State /ZIP: 1 /It ,"- k 6EZ 1 2 e g 2. p 7 ?i5 Floor drain/floor sink/hub 16.60 Phone: ( 5 410 L- ? 3 96 Fax: ( 5153) 47 2. - Xy 33 Garbage disposal 16.60 r , , a 2-• :. !r � • Hose bib 16.60 ',- Ai,5; =-:19 .I5IC1A1S11P . • . -7 . CONT1,,ii 1 �, { ,1:!: Ice maker 16.60 Business name: a i a p, A lives Interceptor /grease trap 16.60 Contact name: k.e AS 0 TA. fZ- Medical gas (value: $ ) Page 2 Address: /? Z in d Sc..) '14 5 A u r Primer 16.60 City/State/ZIP: �k1 t!a, .(, + A i 0 A_ f ?Q L z _ g 2 2 6 Roof drain (commercial) 16.60 Phone: ( 39-6 ( 2. 3 3 .76 Fax: : (563 G 4 2 -54(33 Sink/basin/lavatory i 16.60 Tub /shower/shower pan 16.60 E-mail: /l G . Ce:row► :u ' � r ' o � �� � N � Urinal 16.60 � ' ?t e !- !.. ,`� s. :!• 0?:N1I tc0,... e ' t ,7,"r,, n , - Water closet 1 16.60 Business name: --ri A., .IL ,< tsas.. ` A Water heater 16.60 Address: t�• 0. /3 0? 2 2 y r Other: City/State/ZIP: A 1 a C 23 Subtotal ty �'� S f i Ngf f / 7 Minimum permit fee: $72.50 Phone: ($'03) 77?-2.3 v/ 3 a` Fax: ( 503) aro - gZ 12 Residential backflow minimum permit fee: $36.25 CCB Lic.: / 07 7 9 z r Plumbing Lic. no.: 3-23-7,05 Plan review (25% of permit fee) State surcharge L fee) Authorized signature: ( I TOTAL PERMIT FEE Print name: 14165 4 l/ / 4,td • , Kse 74 Date: Z-2?-0 8 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. I:\ Building \Permits1'LMF- PermitApp.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: ►�11tE` des Q ty • Fee (ea) Totlil ' �. .. .. Sguare Footage ° .. : germt-Fe�..: _ Footing drain - 1" 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 � 31y/0 7 Water Service - 1st 100' Pk; ,z( r f f 4 45614- IoP � Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 al » ta t iOn $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` > ` 90' > l ee ^(ea T 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 specially requested inspections - per hour 72.50 and including $50,000.00. 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: Plain= Review` for:Fllumb qg I t'stallatio 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 'Qua iittb tOtittute)MorkPcrfdrrued"' greater, except systems designed and stamped by licensed en ' ineer. a , � • • t i�� ,: g .- Prev.iW . v.ceaa t _;Aaa " Exishaa : ❑ 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 S i gmetne or RY�er D agram 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 ar re diII fixture work: Disposal - Commercial regarding - 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: i:\ BuildingTennits \PLM- PeimitApp.doc 12/27/06 Electrical Permit Application FOR OFFICE USE ONLY • - . City of Tigard \ECEIVE 111 P eceived Date/B : or ii" 0 g /377 Permit No.: rrIST,20105 —. CAki ' . . q 13125 SW Hall Blvd., Tigard, OR 972 3 r ._ gp CI) LUUti Plan Review • M . - Phone: 503.639.4171 Fax: 503.598.1960 1 thd h. .., Date/B : Other Permit: A . .., .. ..— , , TIGARD Off Y O fiGARD D Inspection Line: 503.639.4175 Juris: HI See Page 2 for -1.5-! F , e Internet: www.tigard-or.gov ;.* Supplemental Information ,,, tomeDvisr!, , , - - - --- - - - - - • .- Notifi ifi Ready/By: :,::.1 :::,' •-••,:.:,:,::"..,-,-- , i -, ;g:tis. , * . ww,Nt- ,1 ..c7H.I.F;i , .:::=.-i: New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. ,4:;,1:5i3;;;..,'-:...•.i:g:::. ' ?- ';:'.:'.. exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground, or exceeds 14,000 0 Commercial-use agricultural I- and 2-family dwelling 0 Commercial/industrial 0 Accessory building RZ amps for all other installations. Multi 0 Master builder 0 Other: buildings. 0 Fire pump. 0 Installation of 75 KVA or larger separately derived system. ! : i;f;' 0 Addition of new motor load of Job no.: Job site address: 13 2 2 e 5 Af4A70.4.; a 100HP or more. occupancy. re.< Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: 77.24-1 6 A- 7 7 22.3 0 Health-care facilities. I:1 Supply voltage for more than 0 Hazardous locations. -- 600 volts nominal. Suite/bldg./apt. no.: Project name: 0 Service or feeder 600 amps or more. '• ::*.' ' =:I i .,....;''' , -', .:i• '' Cross street/directions to job site: /41( 4 4...! j- 7 test Description I Qty. I Fee. I Total 1 • New residential single- or multi-family dwelling unit. DA' 4. A. e t 4 0 6 le C...3 e 0 .c ( Includes attached garage. Subdivision: 6 lidosed1 4114 Cc( uP312-1 , 0 Lot no.: ( 1,000 sq. ft. or less Ea. addi 500 sq. ft. or portion i 145.15 4 33.40 1 Tax map/parcel no.: as/ 0 X 0 C. 65 - Limited energy, residential ' 4 ' i l :k . „ '. ;11... : :: ;' ,,4, -..:: ::: :. 1 ', . ': 7 ! (with above sq - ft) 1 75.00 2 Limited energy, multi-family AI e c.4.3 1 1 Ai -e• residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 AI.T. t;t;`,..;;.;:: 0 .4ENAN'i 201 amps to 400 amps 106.85 2 N 401 amps to 600 amps 160.60 2 ame: G ,s.. tz.... Com,,-ii#4 ce c eg Al 41 hic. • 601 amps to 1,000 amps 240.60 2 Address: / 7 Z 5 co I 1.:14 Over 1,000 amps or volts 454.65 2 City/State/ZIP: / int — 82 Temporary services or feeders installation, alteration, and/or 7: a / %tr f 7 7 (3 4 2 ? 0 relocation Phone: (.5 4 ? 2 — 3 3 7 O Fax: (r05) 6, 7 2 —5--c 3 3 200 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, 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, per panel Owner signature: Date: A. Fee for branch circuits with i ,': " U`, ,.''. ,..;? J i .a.,‘ CO **,o*:ot400ke.;J ,y ,p','::: above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, Contact name: first branch circuit 46.85 2 Address: Each add'I 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 0 - .; , :.',' , .,4'.:',:.: . :i!".',.. k : , ''' :; ,`',.':,', 1 ',('°?,..:.";;;.;::; - : . :! ; , :=.,',.;: Sign or outline lighting 5340 2 Signal circuit(s) or limited- Business name: D ke i‘istev.,( e 4, f"..c.... 4C., energy panel, alteration, or Address: /0 4 3 7 5 E /ce 1/ fid. extension. Describe: Page 2 2 City/State/ZIP: / ArZ R 1 2 2, 2 2_ Each additional inspection over allowable in any of the above Per inspection 1 62.50 Phone: ( .S1 ) 7 S C.- C) 8 SC Fax: (Sso 3 ) 284 -. Z. a t Investigation per hour (1 hr min) 62.50 CCB Lic.:y3 9 Electrical Lic.: 24 3 Z (C. Suprv. Lic.: 2.s / ys-- Industrial plant per hour 73.75 ;'. - . , :::-. :, ‘ErSEOWAt01. Suprv. Electrician signature, required: a.ezie., Subtotal: Plan review (25% of permit fee): Print name: 04 /e i 0 v ic ‘ e : iew. Date: .4 —z?—es 8 /4 „.......,41 State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Cad) NeX ea_ Date: Z-Zy. it'd' days after it has been accepted as complete. * Number of inspections allowed per permit. l:\BuildingWennits\ELC-PermitApp.doc 05/23/06 440 I/05/COM/WEB Electrical Permit Application - City of Tigard . Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check T e of Work Involved: A udio and Stereo Systems* E r-Burglar Alarm Gara Door Opener* d Heating, Ventilation and Air Conditioning System* Er Vacuum Systems* Er &its) em k- el , frA , RG V Q> ®NLY R s 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 ❑ 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 I:\ Building \Permits\ELC - PermitApp.doc 03/23/06 Mechanical Permit Application FOR OFFICE USE o;l City of Tigard g R i■, n vea �d� eAs. Permit No.: ° 13125 SW Hall Blvd., Ti ard, OR 97223 LW . y. i " t�LY/6S ` Phone: 503.639.4171 Fax: 503.598.1960 Review i ZOO; DateB Oth Permit: • � T I G A R D Ins Line: 503 F E B 2 9 2 0 0 1 . S 1 Internet: www.tigard- or.gov Date R ea d y B y: 7ur is: El See Page 2 for aant OPTIC) i � /I R 1 Notified/Method: Supplemental Information ll +, x, xu 4 y` > r ,, 1` P;E OF+ WORK 4 : ;: :1 MMER FEE *` S CIIE CIO,' ;[St�' , .. • ;:,: DUl?Et '�fiJSE�CirIE 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. : CAT EGORY OTC CON Value: $ • Commercial/industrial RESIDEN EQF.1IP460t / X1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building • For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: wf�; Y t re, t .. Description Qty. I Ea. Total D t' , . ; t . }, `, ,,.. ,-,.. , SI ; OI A AA N1)i I - - „ - - It s ,, _ t,y '.. Heating/cooling Job site address: 3 s c4) /1/4 !L O Air conditioning or heat pump �, /� / me a (requires site plan showing placement)' 14.00 City/ State/ZIP: ! ` ¢ Q� r� � 2 22_3 Fumace 100,000 BTU ( ducts/vents) 1 14.00 V 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: /A 1/ s1G We 4 N Duct work 10.00 4ti 4 1 / / Hydronic hot water system 14.00 rt4 4y 0° Residential boiler (radiator or ✓ C W cC hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: GeQ /o,. s Lot no.: / Flue /vent for any of. above 6.80 S O/V �df Lot [ Other: 10.00 Tax map /parcel no.: Other fuel appliances .' Fr ; i j . W ater heater < _ ::)i... ., ,.. ,D GRIP3iION .. OB�vWORIC; „.,- 42: -, :,:.„:',: , '•::. 1 10.00 At e t /IC #141c- Gas fireplace 1 10.00 / 7 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 . r ti;' In jtR.*o t r r � , . s . ®t,, , z, , , ,r - Chimney /liner /flue /vent 10.00 Y s nt •t•>: Y,, ,, r'r� , ! r .:. `s., 6 ;'0i .-.Mel£ ti ru,.N. T•, ,, -., lt�l e � !4s 0,:%,:v fi s.,;: ”' ' " � Other: 10.00 Name: G e fuck Ce /.! t 25a.“. jt 4r t.► Cam lr L- Environmental exhaust and ventilation Address: / Range z Q w Y -E� Range hood/other kitchen t T V Y equipment + 10.00 City/State/ZIP: /14 s (d )et ` og 7706 Z g 7 7 C5 Clothes dryer exhaust 1 10.00 Single -duct exhaust (bathrooms, Phone: ( 5'63) 4i2....- 33 Q 6 Fax: ( Ta3) G ?2.. - SYS 3 toilet compartments, utility rooms) L i 6.80 Attic/crawlspace fans l�f /? •t ':'� fci (�,.AI'I�LIG`AI�El r�j°`r. n 5 7 •.`. r5;µ . °�L' Ii CUNi'A�'1�.P1�RgQ)•i; �" .... P 10.00 ,e Other: 10.00 Business name: G eat Ce�ffe.o.,, 4° o 4,c., Fuel i in PP l; Contact name: `(, a eft_li. �/ ,{ A $5.40 for first four; 51.00 for each additional p Address: / 7 2 0 S 43 V t+ V t_ , Furnace, etc. 1 Gas heat pump City/ State/ZIP: I L 4 C4 f//Y � f q 2 d C2 - g 7 7 Wall /suspended/unit heater Phone: (3'O3) G r Z. 3 3f Q I Fax :: (5-o 5 6 Y 2 ...... 5 - v 3 3 . Water - heater I E-mail: `<' ( �)a q t�e�2 -e e . e= o Fireplace w1 Range I •� Z71 $e_ a t << `� 1 ; s� Y F •ss t p �'' F r" r r ,�4 4t i ` .i . Fi �*. U rsa' .1:1 .�..-�:': 1;,3n '1', 2 sQ.Z�i•, �`' a, ?, ... ,0A:5- P. . e: :;;*,:tt?'. --; Barbecue Business name: O ti G `K 1 Clothes dryer (gas) t� 4 Other: Address: / 0 0 0 o >e / ! t , � 4!, « J 4i C City/State/ZIP: , 4 , to t�ite e k OR 7 7622. Subtotal 4 Minimum permit fee ($72.50) Phone: (s6 3) 6, 5-5 d Z Z. ( Fax: (503) 4 Ste) 2 / q ' 3 Plan review (25% of permit fee) CCB lic.: 1/ 2 S'! ? State surcharge (12% of permit fee) d, 4 TOTAL PERMIT FEE Authorized signature: T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: g.,,, g, 5 Date: Z — 21 8 • Fee methodology set by Tri-County Building Industry Service Board I :\Building\PermiuU�C- PermitApp. ? c 01/19/07 440.4617T(II /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information - • • _ . Commercial Fee Schedule: ' Eigr $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. IABuilding\Pennits\MEC-permitApp.doc 01/19/07 2 " Elev 209 Elev 210 Elev 212 54 Elev 214 gm . Olin o i i •/ 15. i `'�� . (\ \ 14 1 41 1 0 5.00 1 L 1 ,S / 7 SQF 00 I TREE PLANTING SCHEDULE �. I - I `/. / j r�e.tu..aatws.rtar.r �) / I w - s.. na..aeaN a.r. 1 want ® owr w I . .. doe um 211 on I _rip 0 o p „ 8' PUE I y. .pL , ,�. 1 4 . 5 1 1 Elev 15.5 ' Qp w.==rol « .a.. 0 M I ...,.b...m.....a..tm.� z en Let 41 *brit Oa Pon cal M cn e . M. 16 59 I ! �� ® ®� L1.1 _ f p, , - irti 0 i atioull 0 1 CD I I I z 111 a �o � ; 1 Elev 215 .33 ' I I I �� �9 1 . I I I I co 1F — ND 1 0 ' I � - ■Grave ve � . 1 for ..n i CD a � o 0 . 1I N A �r► ��I�i�+.�'* I%�18' PUE �( 1 ! �glk WARNING: Ill eRI ,., OBTAIN LOCATES PRIOR TO ANY Elev 210 Lu EXCAVATION 56.62 Elev 216 U Ln LCY®: T C r CONSTRUCTION • .. , } _ COMPANY INC. HOME SQUARE FOOTAGE BUILDING MAIN FLOOR =1139 sQ.Fr. CUSTOM HOMES SINCE 1977 lis U PPER FLOOR =1431 SQ. FT. (503) 692 -3390 / TOTAL = 2570 SQ. FT. 13778 SW Halcyon Terrace GARAGE = 480 SCUM Lot 1 Gertz Homes at Edgewood SCALE 1" = 20' GERTZ CONSTRUCTION COMPANY INC. PLOT PLAN 4/8/08 , /3 778 SO...) a c , 0 , 1 Te►'rc�ce CITY OF TIGARD - SITE P LAN REVIEW I BUILDING PERMIT NO.: iM .- cc.. 5 PLANNING DIVISION: Required Setba ks: [Approve S 0 Not Approved Side: Street Side: Front. ,-20 Ga ice: 20 Rear: IS Visual Clearance: ar Approved ❑ Not Approved Maximum Building Height' feet CWS Service Provider Letter Required: ❑ Yes ❑ No ❑ Received ikttlyj Date: [ ENGINEERING DEPARTMENT: Actual Slope:.S % VI Approved ❑ Not Approved Site Pl b: j ❑' Approved ❑ Not.Approved Ste: ' l 14- y _ Date: 1 1 - r e Notes: o 1 /24x- G(- un11,>.4,JA-ouo `:C TA{ OF TIGARD - SITE PLAN REVIEW '• PERMIT NO: Street Trees: Approved ❑ Not Approved Protected Tree %Approved ❑ Not Approved By: !o c'tt P ica- Date` 7 <25 (Jf�' Notes: Oregon Residential Specialty Code N1107.2 ► sk i 2a~ — O30j HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: oe r 000 1 s Jurisdiction: 7! 7/04-4 GNZ- Site Address: 1 3 ? 7 $1 - Subdivision/Lot #: ` and/or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: Date: �� wner /General Contractor /Authorized Agent Print Name: Vl., ' ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. 1: \Building\ Forms\ RES- HighEfficiencyLighting.doc 07/01/08 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I,r / , am the general contractor or the owner - builder at the following address: Site Address: / 3 7 g . s . / �' ✓ !/� l City: / Permit #: c9-6 pe l s Subdivision/Lot #: t u/ � and /or Map and Tax Lot #: To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918 - 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: `� �° %� / Date: 7 / 2- 0 General Contractor or Owner - Builder I:\ Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION { . 1, , Owner /Agent for (PLEASE PRINT) (PERMIT HOLDER) 1 Do hereby certify that the followiriglocation meets City of Tigard land use and 'development standards • for = street tr ADDRESS: 7 • r / . SUBDIVISION: Gv" LOT: SIGNATURE: / , DATE: OWNER /AGEN ( T ) RECEIVED BY: DATE: (CITY OF TIGARD) 1: \Buil ding \Forms \StrcetTrceCertificatc 01/19/07 ' r RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: l// ` 2Qae --006/ ,s Site Address: /3 a sc.() Ala /c y©yi 'retrace Subdivision: G ,..\ F. "-k m , c 4 G 1 y Lot No.: / Contact Name: keit (.-? eir .} Business: (7 z (oil Sl ✓v / -� c'too, 6 �Hc . l/ Street: (! 0 SLU G / C 60 ,l tie Cit / 4 . 1 14 State: (3 j? Zip: G� 5 As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or "complex" as defined in ORS 455.467 and 455.469. M' The application is complete. The application is incomplete for the following reason: ❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. ❑ The submitted plans cannot be reviewed until the above information has been submitted and /or approved. ❑ The plans are deemed "simple ". F i The plans are deemed "complex ". • Signature: < !2— ~- '3 - Q 8 Name: Brandon Shaw Date Title: Plans Examiner Phone: 503 - 718 -2425 E -Mail: BrandonS @tigard- or.gov I: \Buil ding\ Forms \RES- PermitAppRevw- Blank.doc 1/18/07 Mechanical Permit Application i.t)lz c)1 l I( 1)Sh ONI 1 - ��Received l S City o f Tigard l ) ' ; 3,, , ".:a3 DateBy: � t �II Permit No.: ) 1 � l m. 4 ' III C q 1 3125 SW Hall Blvd., Tigard, OR 9722 t tit ; j ' Plan Review __ Phone: 503.639.4171 Fax: 503.598.19:1 O Date/By: Other Permit: i i t \ i( Inspection Line: 503.639.4175 t �11` 2p Date Ready/By: See Page 2 for Internet: www.tigard - or.gov V n Notified/Method: BM Supplemental upplemental Information TYPE OF WOR n i'+�C. ut �� C Jt�" . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Addition/alteratio eplace 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 RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 12 y g ❑ 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 Job site address: c,' �' " /� Air conditioning ( 3 7 7 5'v . �Q /Cy,A, / CY (. Cie. (requires site plan showing placement) .1 46.75 'i t --73 . - City /State /ZIP: / Furnace 100,000 BTU (ducts /vents) 46.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 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 / -74,191 '/Nr) f6 Flue vent for water heater or gas J fireplace 23.32 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 Other: 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 piping Contact name: $14.15 for first four; $4.03 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: Clothes dryer (gas) Other: Address: .MECHANICAL.PERMIT FEES* City /State /ZIP: Subtotal !. 6 .75' Minimum permit fee ($90.00) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 5 ,, 61 TOTAL PERMIT FEE Sit 3 6 This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board 1: \Building\Permits\MEC- PermitApp.doc 10/01/09 440 -46I7T (1I /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. 1: \Building\Permits\MEC- PermitApp.doc 10/01/09 2