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Permit
fi t . 766 -- Pe--/ 3 -4LiL17-1 4 " 6 310 Aged �, ' , M MASTER PERMIT a CITY OF TIGARD ; a ' COMMUNITY DEVELOPMENT Permit #: MST2010 -00090 vT(GA 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010 M . * ..:r, ..;1�s Parcel: 2S103CD05900 Jurisdiction: Tigard Site address: 11640 SW FAIRVIEW LN Subdivision: TERRACE TRAILS Lot: 19 Project: Van Noy Project Description: Addition and remodel. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 244 sf Basement: 244 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $99,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 3 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: Y Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0-200 amp: 0 W/ Svc or Fdr: 10 Ea add'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing. N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) VAN NOY, ELDON VAN HULZEN CONSTRUCTION 1 MST Ersn Cntrl 503 - 681 -4444 11640 SW FAIRVIEW LN 2020 KINGS HWY TIGARD, OR 97223 Medford, OR 97501 PHONE: 503- 803 -1558 PHONE: 541- 944 -1452 FAX: Total Fees: $3,170.32 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 t work is suspended for more the 180 days. A • • • . • egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 -0010 through OA • 52 -r ' 1100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issue. :y: 0 // 0 Permittee Si. T ea _z■,.':." (P C.51-4—_ wrpo Peprr� r ank/ a e,/e - c4/ 111 •t CITY OF TIGA MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2010 -00090 I Date Issued: 07/14/2010 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S103CD05900 Jurisdiction: Tigard Site address: 11640 SW FAIRVIEW LN Subdivision: TERRACE TRAILS Lot: 19 Project: Van Noy Project Description: Addition and remodel and Conversion of 180 sq ft to home theater. 12/08/2010: Reprinted to include (1) 400 amp service, (30) branch circuits, and (1) cable /audio low voltage system. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 244 sf Basement: 244 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 488 sf Value: $99,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 3 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 2 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: Y Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 10 Ea add] 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 488 Owner: Contractor: VAN NOY, ELDON VAN HULZEN CONSTRUCTION Required Items and Reports (Conditions) 11640 SW FAIRVIEW LN 2020 KINGS HWY 1 Ersn Cntrl 503 -681 -4444 TIGARD, OR 97223 MEDFORD, OR 97501 PHONE: 503- 803 -1558 PHONE: 541 - 944 -1452 FAX: Total Fees: $4,113.22 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wit be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 52- 001 -0090. Yo nhtain a cop of the ru - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued I$y.,� ��.;---- Permittee Signature: • . I 5501att 5 by 7:00 a.m. for the next available inspection date. This permit card s all 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. 12/07/2010 10:37 5417444465 GARY MIDDLETON PAGE 02/03 Electrical Permit APPlicati01 City of Tigard �? � � ► OR OFFICE r l �t. t.S O SI a 7 p Permit No.: mst2010 -00090 — 13125 SW hall Blvd,, Tigard, OR 97223 n e ( `� 01 0 Pl Review fir' - -- ________ Phone: 503.718.2439 Fax: 503.598.196 C1, otherPermic DateJEy:_ 1%, It I.) Inspection Line; 503,639.4175 Date Ready/Bv: runs: 13 See Page 2 for Internet: www,tigard-or,gov 1 � CITY OF TIGARD Notified /Method: � baton: nation; C0 Supplemental Iafonation; : „ . .... 0 ., rs ii 01(1A1 . , TYPE .OF W R�t-ui1�1,7' L11 V t ,vr d PLAN REViF.'IV • ❑ Now construction 0 Addition /alteration /replacerneot Please check all that apply (submit / gets o£plan3 w /items checked below): ❑ ScrYtvc or feeder 400 amps or a1v1e ❑ Building over three stories. © Demolition ❑ Other: where the available fault etureni ❑ Marinas and boatyards. ' • CATEGORY OF' CONSTRUCTION • • exceeds 10,000 amps at 150 volts Or [3 F,19. 0g buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agrit:ultwal E 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all other installations. buildings, ❑ Multi-family ❑ Master builder ❑ Other: 0 Pim pump ❑ Installation of 75 K VA or JOII 511E INFORMATION AND �LOCATIO • 0 Emergency system. larger separately derived system. , ❑ Addition of new motor toad of [J p:> E 1_2^ 7.3 Job no.: Job site address: 11640 S.W. F'airvelw 1OOItP or more. occupancy. 0 Six or inure residential units. 0 Reca-cational vehielc parks. City/State /ZIP: tigard, OR ❑ health -care facilities. ❑ Supply voltage for more than — - „ 0 llarardous locations. 600 volts nominal. Suite/bldg. /apt. no -: Project oa1.ne: ❑ Service or feeder 600 amps or more. ___ FEE SC/IEDULE Cross rats street /dirtctionS tojob site: SW 115"' Ave _ owc.iption 1 --9.--L---,..-1,..,„ I rte. ,..,,1 __ 121... .i _._ New residential single- or multi- family dwelling unit.- .� - - Includes attached garage, Subdivision; r Lot no,; 1,000sq. ft. or less 168.54 4 --' Ea, add'l 500 sq. ft, or portion 3192 1 Tax map /parcel no.: .Caned energy, residential • DESCRIPTION OF WORK : • • (with above sq. ft.) 75.00 2 - ""'" Limited energy, multi- family 75.00 2 Add to exisitng permit: Upgrade service to 400 amps by Adding 200 amp Feeder residential (with above sn. ft.Z _ - Services or feeders installation, alteration, and/or relocation Add 30 additional electrical circuits. Add Limited energy Cable TV, Phone & Soon 200 amps or lass 100.70 Ell ❑ PROPERTY. OWNER ' • 0 TENANT" ' . 201 amps to 400 amps — ... 1 133.56 I � 3 , _5r., 2 ..,.w._.. - — — 401 amps to 600 amps 200.3. El- - Name: Eldon annoy 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552,26 2 City/State/ZIP: Temporary services or feeders jnstallation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less _ 5936 1 201 amps to 400 amps 125,08 2 O wner i nsta ll at i on: This installation is b made on property that l own which is not ------ -- intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 2 Branch circuits- new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch citcuTts will ® APPLICANT ! ❑. CONTACT PERSON 3 7 2 .,_. _ . ��w...._� above service or feeder fee, 3� each branch circuit .6 � I3usiness name: B. Fee for branch circuits without , service or feeder fee, tlrst Contract name: � branch circuit 56.18 2 „ ' mmw Each add'I branch circuit 7.42 2 Address: MIscellaneoussservice 0r !ceder not *cinder') City/State/ZIP: Each manufactur or modular 67.84 2 dwelling, service and /or feeder — Phone: ( ) - I Fax: ; ( ) Reconnect only 67.84 2 E -mail: ~~ m Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting ^ 67.84 2 Signal circuit(s) or limited- energy Business name: Rogue Electric LLC panel, alteration, or extension. - ! Page 2 7 2 ..„..____ Each additional inspection over allowable in any of the ahoy Address: 2241 Rose Blo t soni Dr Additional inspection (1 hr min) , lir ^� " Investigation (1 hr min) 66.25/ hr City /State /ZIP: Springfield, OR 97477 . Industrial plant (1 hr min) 78.1 hr Phone; (541) 285.7374 Fax: (541) 744 -4465 Inspections for which no fee is specificaf listed (14 hr min) 90.00/ hr CCJ3 Lie.: 192346 Electrical Lic.: C6 j Supra. Lic.: 5064S ELECTRICAL PERMIT FEES Supra, Electrician Signature, required: __ Subtotal: L( 3/, /(, _ __ __. "._._ _ rim review (25% of permit fee): Print name: Gary Middleton Date: 12/07/2010 State surcharge (12%ofperniit fee): 5 / ` il _ TOTAL PERMIT FEE; Authorized signature: ,w., w_ �� y v _ This permit application expires If a permit is not obtained within 180 days after et has been accepted as complete, Print ilAtne mm_ Date: e Number of inspections allowed per permit, 1: l6uildicg \Pbrmitt\0LC- PermitApp.doc 07/01/70 440 615T(31 /O5WCQM/WEB 12/07/2010 10:37 5417444465 GARY MIDDLETON PAGE 03/03 Electrical 'Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: • . . Fee for all residential systems combined ,.. $75.00 Check Type of Work: Involved: ® Audio and Stereo Systems* ❑ Burglar Alarrn ❑ Oara Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other; Cable Tv 8c,PhQne COMMERCIAL WORK ONLY: 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 Fite Alarm Installation ❑ FVAC ❑ Instrumentation Intercom and Paging Systems ❑ Landscape Irrigation Control* Medical II Nurse Calls fI Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: No licenses are required. Licenses are required for all other installations I :\guffltlitt entita4ELC 01/01/10 Electrical Permit Application �� FOR cl r I I c : I; t• I : c w L. City of Tigard � r 1, 010 Received I /� <<i :� q 13125 SW Hall Blvd., Tigard, OR 9 , r'? p1 t a n R view " ~' Phone: 503.639.4171 Fax: 503.598. �'„. % , Date/13 : Other Permit: Tit . , I Inspection Line: 503.639.4175 G � Date Ready/By: see Page 2 for Internet: www.tigard-or.gov � �� ` Supplemental Supplemental Information TYPE OF WOR � PLAN REVIEW ❑ New construction ❑ Addition/alteration4MAdent Please check all that apply (submit / sets of plans w /items checked below): taV' ❑ 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ['Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3 ", // \ /. - p � � 100HP or more. occupancy. Job no.: Job site address: / / t0 11 0 Fa ru t C.� ' - 4 6 ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 A /; Limited energy, multi - family 75.00 2 �l 0\10 CC1NfY?A a ' Pa('M /� residential (with above sq. ft.) Vv r Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: - Over 1,000 amps or volts 552.26 2 City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alteration, and/or Y relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or ex tension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 {��� / CONTRAC'OR Signal circuit(s) or limited- energy Business name: � /(e e panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 990 CC / 7 `= Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Gvf 0P (9µ Investigation(1(rmin) 66.25/ hr Industrial plant 1 hr min ) 78.18/ hr Phone: (Syr) 253 73 J n / Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%] hr min) CCB Lic.: /19a7' tur Electrical Lic.:e Suprv. Lic.: .�✓ 64YJ' ELECTRICAL PERMIT FEES e, it I / I I 117 f / � Z Subtotal: Suprv. Electric' / / / 3 Plan review (25% of permit fee): Print name: � 4t,ZG/ f d ie.,4 ,, ,' Date: //...r...../0 State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Num o inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 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* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: 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* • n 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 07/01/10 Building Permit Application Residential REC I OIt.OI I ICI: 11tiF:' \L.1` . City of Tigard Received Permit No.: ° 131 Hall lvd., Tigard, OR 97223 MAY 2 5 2010 Date/13 •: 5 A 5 to , Horg 0 -ax�Yd Plan Review. ��w�� Phone: 503.639.4171 Fax: 503.598.1960 Date/I3 : 7. Q Other Permit: T I G n It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready : 7 1u • ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION N.tified/Method: C. Tr" � \` / � Supplemental Information L % Ji'� 1' / , . t. U " 161'.0") TYPE OF WORK REQUIREDDATA: 1- AND 2- FAMI 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 12 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ' work indicated on this application. • CATEGORY 'OF 'CONSTRUCTION . . • 1- and 2-family dwelling Valuation:_ y g ❑ Commercial /indusVial ❑ Accessory building ❑ Multi- family Number of bedrooms t l� 000 ❑ Master builder ❑ Other: Number of bathrooms: . JOB SITE. 'INFORMATION AND LOCATION'. Total number of floors: Job site address: 1 / , L' r7 $ W (c: ✓t/ e+✓ L/✓ New dwelling area: L e ..,_ square feet1 (� City /State /ZIP: - r.'9 < 0 e2, q 1 ZZ 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: VA n/N() % Covered porch area: square feet Cross street/directions to job site: / Deck area: l square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST : , Subdivision: Lot no.: j y Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: S q ° 0 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK ' : , .. work indicated on this application. Valuation: $ A dU,'7 tovi 4hcp eg4•"°Lt. I Existing building area: square feet New building area: square feet (.'PROPERTY OWNER _ •- ❑ TENANT, Number of stories: Name: / J w\ V'.- , j /p y Type of construction: Address: I I G q . y„/ F 4 , t/' VI? f L/✓ Occupancy groups: City /State /ZIP: "r; y c /' / ) n r q --71a_3 Existing: Phone: ( 5 e ,3- /55-8 Fax: ( ) New: • ' ❑ APPLICANT, , ' ' 51 CONTACT PERSON . • :;NOTICE : • " . Business name: /Y'$ z7 &DCr 6i ei All contractors and subcontractors are required to be Contact name: ✓P /t/Y-5 with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: j - 2 -:j c, S W' l> �? 1 1 4 ✓Q jurisdiction in which work is being performed. If the City /State /ZIP: r . ' y� DC 722 3 apply: is exempt from licensing, the following reasons pP l y: Phone: ( 4-�) 2415 / G 7 Z( Fax:: ( ) E -mail: C, Q km o, . ga �o, Coo • � ` ` . CONTRAC`YOR . '. Business name: `/J1'\ `4 U -(_7_,1_, C (0 IL) BUILDING ,PERMIT FEES*, _ Address: ACIAO___ 1IvC95 (Pteaserejer,tojeeschedulej , City /State /ZIP: M E b s o a k b ( 0 a 7 So Structura p review fee (or deposit): Phone: ('5 ) 9 ,/y" 7 L�/ m Fax: ( ) FLS plan review fee (if applicable): Total fees due upon application: 4 y. (it CCB lic.: 155 GALQA �_ Amount received: Authorized signature: This permit application expires if a permit is not obtained tn1 within 180 days after it has been accepted as complete. Print name: ( cye� V 4/c / Date: 5 ----1 5 -_ f 0 * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 1 0/01/09 440- 4613T(11/02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling I t)R OFFICE Iel• I tit; ()NIA. , - City of Tigard Received permit No.: a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: �' , El ❑ Plumbing ❑ Mechanical a;r 24- Hour Inspection Line: 503.639.4175 Internet: www.tigard-or.gov El Other: V•1 11F •I OLI;; OWIN(. ITEMS-Ala IRFOUIRFI) FOR PLAN RF.\!II \V j Yes No N/A.. 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. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore :on and shall be shown to be applicable to the .ro'ect under review. ' .IURISDIC ! ION/ \I ' li CI1 IC I , . • 23 Three (3) 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 must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non- impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Permits\BUP- RES- PermitApp. 03 /21/06 440- 4613T(11 /02/COM/WEB) . . Electrical Permit Applicati ErplvED '' I City of Tigard DateB / Permit No.: Nb'r,2 t t� _ F. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review B Other Permit: Phone: 503.639.4171 Fax: 503.598.I RAY : Inspection Line: 503.639.4175 R� , � Y 2 5 2010 Date /B Read B Ju ris: Se Page p Ready /By: e 2 for B Internet: www.tigard- or.gov Notified/Method: Supplemental Information • . ce OF TiGnRD TYPE OIByf IJ DIVISION PLAN REVIEW ❑ New construction V 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 ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", I 100HP or more. occupancy. Job no.: Job site address: 16 4 D Sw Fat r V i E (4) 0 Six or more residential units. 0 Recreational vehicle parks. City /State /ZIP: 71 J c � em/cs 0 P 9 22 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 1 Project name: V a N 1 1 o 1 i ( ❑ Service or feeder 600 amps or more. t , � t � t.d FEE SCHEDULE Cross street/directions to job site: q d ulJ - f - p V 1 Description 1 Qty. 1 Fee. 1 Total 1 • New residential single- or multi- family dwelling unit. 6 +o ✓ V j &Aid Includes attached garage. Subdivision: Lot no.: ) 1,000 sq. ft. or less 168.54 4 / Ea. add'I 500 sq. ft. or portion 33.92 I Tax map /parcel no.: L c/ , Limited energy, residential 67.84 2 DESCRIPTION OF. WORK • • (w ith above sq. ft.) Ad Limited energy, multi - family 67.84 2 4 ®5 Rd ( I- 1 a (Ad (e vlA 0 ( ( d residential (with above sq. ft.) F IM f' (46.,,c _ (1 e. Services or feeders installation, alteration, and/or relocation p Gt. ✓t- A s I ✓ t( . t 1 11� V MJ.✓`L Q.. 200 amps or less ( 100.70 0�C . 2 ❑PROPERTY •O�W ER I LJ I ❑ TENANT • . 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: E-14 0l V a v. No(- 601 amps to 1,000 amps 301.04 2 Address: , I tP 4 0 5 w Fik W U 1 2(h1 ),._ awl. Over 1,000 amps or volts 552.26 2 City /State /ZIP: - 11 fwA- ( O F n v 223 Temporary services or feeders installation, alteration, and/or relocation O Phone: (') g4 - (,,- 2) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 a Branch circuits - new, alteration, or extension, Qer panel / Owner signature: ` - �� Date: r 2- S - iV A. Fee for branch circuits with above service or feeder fee, p� 7 A '7Q ❑ APPLICANT 1 ' XCONTACT PERSON • each branch circuit IV 7.42 4 2 Fee for branch circuits without Business name: � S / / 1/4 (,�� QiS B . service or feeder fee, first 56.18 2 m c _ / Contact name: S .& v 5 branch circuit b 2� 0 J (A/ / / - IF -'f'„` ela branch circuit 7.42 2 Address: V e Miscellaneous Miscellann eouus (seervice or feeder not included) ) City /State /ZIP: 7 i ci 0 '2-23 Each manufactured or modular • dwelling, service and/or feeder 67.84 2 Reconnect only 67.84 2 Phone: (50) 24 . - -+++"' 21 F ax: ( ) Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: (/-' panel, alteration, or extension. Page 2 2 _ Each additional inspection over allowable in any of the above Address: I inspection (1 hr min) 66.25/ hr City/State/ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically. listed (%s hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT 'FEES. Suprv. Electrician signature, required: Subtotal: 1 HO Plan review (25% of permit fee): . Print name: Date: State surcharge (12% of permit fee): ZO , 91 TOTAL PERMIT FEE: 1 ei T t 81 Authorized signature: Z.---......--- ✓ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: - fcJ t, V ,,, Date: S - ZS= /(0 * Number of inspections allowed per permit. 1: \ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information . . LIMITED ENERGY PERMIT FEES: ; . RESIDENTIAL WditkONLY Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ A udio and Stereo Systems* ❑ Burglar Alarm n G arage Door Opener* ❑ H eating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: 1. COMMERCIAL WORK ONLY 1 Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \Building\Permits\ELC- PermitApp.doc 10/01/09 Mechanical Permit Applicatio n \/ Olt OF l I(1 I,,i O`'. " ..... "T1 City of Tigard MAY 2 5 2010 Date/By: ed ` S 2 (0 m �I 90(0.. 000F0 i lliq . q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Date/By: l/ Phone: 503.639.4171 Fax: 503.598.196 Other Permit: gCl1 OF ► IGARD i - i t:, A RI) Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information ' TYPE OF WORK COMMERCIAL FEE* SCHEDULE - ',USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction gl 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* M 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total • JOB SITE INFORMATION AND LOCATION : Heating/cooling 1 ( 6 V S F� • trey., _/ Air conditioning Job site address: 1 � ►� �� � /' (requires site plan showing placement) 46.75 City /State /ZIP: T "`qcv I M2. t `1 -7 22 3 Fumace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: V/4 /✓/Vo y/ Heat pump 61.06 6(.c , 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 !l Flue /vent for any of above 23.32 Subdivision: Lot no.: / ` Other: 23.32 Tax map /parcel no.: 5' 9 Oo Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 • Gas fireplace i 33.39 33.(' 4 iSC ) 4 ,.'7‘) 1 O , - , 6.? /( ,t e/ Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 I 'PROPERTY OWNER I . ❑ TENANT Chimney liner /flue /vent 23.32 Other: 23.32 Name: I' /doh V4t., n/ey Environmental exhaust and ventilation ,� Range hood/other kitchen Address: 1 / 6 q D .$W >C<. /VIP �i// equipment 33.39 City /State /ZIP: 7`; y,j- -, d 4 / q-7.2-2-3 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, / ,� Phone: ( 5 503) 80 3 - / 5- s- p Fax: ( ) toilet compartments, utility rooms) 2- 23.32 4L I4 • _ • .❑ APPLICANT • 'CONTACT :PERSON : ' Attic /crawlspace fans 23.32 Business name: /� /S 4- s$ cT A r '2_i Fuel 23.32 Fuel piping Contact name: /✓'r1 $14.15 for first four; $4.03 for each additional Furnace, etc. Address: 11 2- fi S ti Q ter O 1 ti 4 I/4 Gas heat pump City /State /ZIP: ii y 4c o q ',ZZ 7 Wall/suspended/unit heater Phone: (GO3) Zq 5 - ('/ "2-) Fax:: ( ) Water heater Fireplace E -mail: VI, S. Q 5 S o G G jA O h (j 0, C (/). Range . C N TRACTOR • • Barbecue Business name: Clothes dryer (gas) Other: Address: ' • MECHANICALPERMIT FEES* City/State /ZIP: OW { v L� Subtotal ()k ( 61 Minimum pe rmit fee ($90.00) Phone: ( ) Fax: ( ) Plan review (25 o f permit fee) CCB lic.: State surcharge (12% of permit fee) 1(c .q TOTAL PERMIT FEE I ` t -(2) f signature: -' This p ermit application expires if a permit is not obtained within 180 Authorized si ✓ days after it has been accepted as complete. Print name: , 14a t^ U sti ArC) y Date: 5'-2 S -1 0 * Fee methodology set by Tri County Building Industry Service Board C \ \ \ M Building PermitsEC- PermitApp.doc 10/01/09 / 440 -4617T (11 /02ICOM/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 •Plunlbin Permit A lication Building Fixtures . EC,FI p OR ( -1 l lc r 1�s1 �Nl N , City of Tigard Received i CO pe No.: t 77 - A010-4009 g 5 201 DDate/By: 5 a5 c • 13125 SW Hall Blvd., Tigard, OR 97223 MAY Plan Review ' 0 Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.: .1.1(, 1t 1 Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: la See Page 2 for Internet: www.tigard - or.gov BU ILDINn Notified/Method: Supplemental Information TYPE OF 'WORK , tYlt [�jt��S�� • FEE* SCHEDULE ' ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total 1 21,Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB .SITE INFORMATION AND LOCATION Site utilities: Job site address: 11(- D S ) 6 v i -e,(,0 [ MA e, Catch basin or area drain 18.76 t Drywell, leach line, or trench drain 18.76 City /State /ZIP: Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 5 Vvt CL l( a. ct c ( ( 4 SO SF h vvd Dishwasher Clothes washer 25.02 Dasher 25.02 \r 0 ie., 0 9- J t-p-lu bbl t I i j Q5 I 64- Drinking fountain 25.02 (� Ejectors /sump 25.02 • ❑ PROPERTY OWNER I ❑TENANT • Expansion tank 12.51 Fixture /sewer cap 25.02 Name: [ nil vat, N © Floor drain/floor sink/hub 25.02 Address: i' C 40 SW Fki-r -v eW 1,, a IA e /� Garbage disposal 25.02 City /State /ZIP: T �` t . / OR 9 Hose bib 2 25.02 50,6 Phone: (5'03) ' b ) 6-5 V Fax: ( ) Ice maker 12.51 • . ❑ APPLICANT, CONTACT PERSON Interceptor /grease trap 25.02 Business name: N S Ass , G T a #4.0S Medical gas (value: $ ) Page 2 - �� n ' Primer 12.51 Contact name: / V n Roof drain (commercial) 12.51 Address: ) o2 C LI / 90 J (A) 5� k' - Sink/basin/lavatory 4 25.02 00,6S City /State /ZIP: -T j U ,y 4 0 2 Solar units (potable water) 62.54 i Phone: (5-03) .Z4 -- 6 - , Fa : ( ) Tub /shower /shower pan 3 12.51 '?`7.73 (_ Urinal 25.02 E -mail: y U S t ct gs 0G ^J Q, Vl 0 0 C !1`YV1 J / Water closet ^ 2-- 25.02 .CONTRACTO C14 Water heater 37.52 Business name: Water piping/DWV 56.29 Address: 060kJEIL Other: 25.02 City /State /ZIP: Subtotal . 2 �"] . ( ) Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 -_J CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) , •52... Authorized signature: Z-. -- --%r TOTAL PERMIT FEE `� 7i (2,2,1. Print name: 6 d y Date: 5 = � C� T his permit application expires if a permit is not obtained within 180 days °�'� h � ► O after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\ Bu ilding \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) • Plumbing Permit Application - City of Tigard - ' Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities • ; .. 'Q� Fee'(ea) Total Square Footage: . : .• Permit Fee: Footing drain - 1" 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 • Storm &Rain Drain - 1st 100' 62.54 • Valuation: • Permit 'Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for - Other ,Ins ections,or'Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to P and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. • Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: . Replace greater, except systems designed and stamped by licensed Previous Capped' Added Existing engineer. Baptistry/Font Tub /Sowr ❑ New exterior plumbing site utilities for any complex structure Bath - hower Tub /S erlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash :Isometric.orRiser:Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. Car Wash Drain Garbage - Domestic Disposal - Commercial Industrial Comments regarding fixture work: Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal - Other Fixtures: 1:\Building\Permits\PLMF- PermitApp.doc 2 Property Owner Statement Regarding Construction Responsibilities 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: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or E I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. ___E1 1 1° 1 1 V h 1✓O Print Name of Permit Applicant �.� 7 /Y % v Signature of Permit Applicant Date Permit #: H `c}t AOC - 00090 164 0 ` ice.) rA ia_j(EL7 Address: •���;��,� - at D 4 7 2'2-'7 Issued by: Date: CL- This Copy for Permit Offices C Plumbing Permit Application V.0\01 Building Fixtures , �i,,. ` , l OIZ cal I ICEtisl: oN ma City of Tigard D Received Il � ` a ateStReview y: Permit No.: s f III ` i!I V ' n 13125 SW Hall Blvd., Tigard, OR 97223 J C - Phone: 503.639.4171 Fax: 503.598.1960 �-�'�+ ' G A y . Other Permit No.: Inspection Line: 503.639.4175 ` �`� r� � HOARD C\ a (%. t/ Date Ready/By: runs: ® See Page 2 for . Internet: www.tigard- or.gov ` N otified/Method: " �` ,,1%, VA I � (p Supplemental Information TYPE OF WORK C) " • 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 (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen - 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 . JOB SITE INFORMATION AND LOCATION Site utilities: / U / �J Catch basin or area drain 18.76 Job site address: I I �Q _ I O (.� i r - U t [� • Drywell, leach line, or trench drain 18.76 City /State /ZIP: Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Projec :• - j • Manufactured home utilities 50.03 Cross street/directions to job Manholes 18.76 j ^ _ / ^ Rain drain connector 18.76 � �l n ' (� Au Sanitary sewer (no. linear ft.: ) Page 2 N Storm sewer (no. linear ft.: ) Page 2 ` Water service (no. linear ft.: ) Page 2 Subdivision: k ‘. \ I Lot no.: Fixture or item: Backflow preventer 31.27 Tax map /parce o.: ■ p DESCRIPTION OF WORK Backwater valve 12.51 NO , ` 1 u Clothes washer 25.02 I �/ d 1W.S r v S 7 d nv .e / e�Nw� Y Dishwasher 25.02 '(Y \ cfL f(VC.r( 6■3 p,rit/n r- Drinking fountain 25.02 P1.-,( ( Ejectors /sump 25.02 ❑ PROPERTY OWNER • I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ' ❑ APPLICANT , .. . ❑ CONTACT , PERSON . . Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 • Water closet 25.02 CONTRACTOR ,.� Water heater 37.52 Business name: . ....// / . ....// / / d/ 4, r ,yam Other: 25.02 c,., „ , 4 s 6,46 Water piping/DWV 56.29 Address: 69/13/ , s /it ��9 City /State /ZIP: i e 1 " 6 4 � � � `, ? 3 ( _ Subtotal Phone: 15 3;19...../3-__2_8- Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: a . lttmbin Lic. no.: / Plan review (25% of permit fee) �/��r,, Ia ' u 71 / i \ State surcharge (12% of permit fee) Are Authorized sigtl(Tfe1 TOTAL PERMIT FEE Print name: < o t z Date: 7,8/�� This permit application expires if a permit is not obtained within 180 days �d after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1 : \Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) BeamChek v2.4 licensed to: nys associates Reg # 2308 -64023 van noy addition- revision Header, Master bedroom- flush Date: 9/23/10 Selection I (2) 2x 10 DF -L #2 Lu = 5.0 Ft Conditions NDS '91 Min Bearing Area R1= 0.8 in R2= 0.8 in Data Beam Span 5.0 ft Beam Wt per ft 6.74 # Reaction 1 TL 517 # Reaction 2 TL 517 # Bm Wt Included 34 # Maximum V 517 # Max Moment 646'# Max V (Reduced) 357 # TL Max Defl L / 240 TL Actual Defl L / >1000 Attributes Section (in') Shear (in TL Defl (in) Actual 42.78 27.75 0.01 Critical 8.14 5.64 0.25 Status OK OK OK Ratio 19% 20% 4% Fb (psi) Fv (psi) E (psi x mil) Fc l (psi) Values Base Values 875 95 1.6 625 Base Adjusted 953 95 1.6 625 Adjustments CF Size Factor 1.100 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress 1.00 Cm Wet Use 1.00 1.00 1.00 1.00 CI Stability 0.9897 Rb = 11.27 Le = 10.30 Ft Kbe = 0.439 Loads Uniform TL: 200 = A Uniform Load A R1 =517 R2 =517 SPAN =5 FT Uniform and partial uniform loads are Ibs per lineal ft. .. ... - 7. .,,,,,,,; . ::: . . 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