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Permit g 1 1 Ito ` �.,..� --._ CQQ ..e_i_ � P _0"0.... e teLiA_ . CITY OF !GARD MASTER PERMIT 4 COMMUNITY DEVELOPMENT Permit #: MST2010 00052 T I G A.R.D. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2010 Parcel: 2S114AD04000 Jurisdiction: Tigard Site address: 16633 SW 90TH PL Subdivision: WAVERLY ESTATES Lot: 39 Project: Borosund Project Description: Creating 283 square feet habitable space in crawl area. 8/13/10, adding heat pump. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 283 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $23,245.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 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) BOROSUND, JEFFREY STEVEN OWNER 16633 SW 99TH PL TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $1,440.55 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. Those rules are set forth in OAR 952- 001 -00 OAR 9522- 00 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ' Issued (�L �CX Permittee Signature: k � , ■ : , v ?'�r • rr+' '� ! MASTER PERMIT 4 a CITY OF TIGARD :11:::,-, COMMUNITY DEVELOPMENT Permit #: MST2010 -00052 Date Issued: 05/04/2010 .T 1 GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S114AD04000 Jurisdiction: Tigard Site address: 16633 SW 90TH PL Subdivision: WAVERLY ESTATES Lot: 39 Project: Borosund Project Description: Creating 283 square feet habitable space in crawl area. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 283 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $23,245.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N 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: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addl 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 addl 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) BOROSUND, JEFFREY STEVEN OWNER 16633 SW 99TH PL TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $1,363.85 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. ATT ' Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 010 through 0 • - 95 :11 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344. Issu By: L..____ I' 0 / Permittee Signature: 1c , _ 4 Building Permit Application Residential I I r� fl h `, 'S` 1012OI I I(I ` ,1�SE -O�NI 1 ;' E -r )- a ' ' N A r 2' l T ,, ' .. . Ii � 11 Received �..„ City Of Tigard DateB ,.... Permit No.: 11: Q •''11 13125 SW Hall Blvd., Tigard, OR 9722 i to ` 0 7 2010 0 0 Plan Review _ � � Other Permit: Ill Phone: 503.639.4171 Fax: 503.598.1' . t DateB ��,*/, l 1(;A It l) 1. I I 1 Inspection Line: 503.639.4175 r . . r , CM _ _ p' Date RReady/By: ®See Page 2 for Internet: www.tigard - or.gov IGARD Notified/Method:5 � t Supplemental Information BUILDING Di1 /ISI( J ? TYPE OF . WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING • ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all (XI Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. vi an d 2-family dwelling Valuation: $ a 5 - a . re, a_ .. y g ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: ) (Ntts ❑ Master builder ❑ Other: Number of bathrooms:6Jew) JOB SITE INFORMATION AND LOCATION '.. Total number of floors: r9, • Job site address: j 5 CJ ``" \ New dwelling area: C J square feet City /State /ZIP: 7 k y_\ � Z "`) Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: "., (t,„._ 1 1 2 l '" c) ° o Ij'.). -.(� Deck area: square feet C QA %\ \. --% -,..,$) G.►v 'L ; 1 ,. - - - • - vo Other structure area: square feet C:j) . Li t'- 1 ` REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. \ N N 5�\ c--1 `� \ �e. - G� /4‘.4- Valuation: $ Existing building area: square feet New building area: square feet g- PROPERTY OWNER ❑ TENANT Number of stories: Name: "�5 —c ..2)' --'�- ` ZS'' A Type of construction: Address: i r_ 3 5 V` �9- � � 1 Occupancy groups: City/State/ZIP: ""V 3 l CP-- Q Existing: Phone: ( r j ,- ( -®z_ Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E -mail: ' CONTRACTOR ' Business name: <n.) t-) -- BUILDING PERMIT FEES* Address: (Please refer to fee schedule) . City /State /ZIP: Structural plan review fee (or deposit): aF)5, 1, C r i D Phone: ( ) ( ) FLS plan review fee (if applicable): Fax: CCB lic.: Total fees due upon application: Amount received: Authorized signature: ��� �.r This permit application expires if a permit is not obtained \ within 180 days after it has been accepted as complete. Print name: • --. V I �� ,_, Date: y 1 1 L c; * Fee methodology set by Tri- County Building Industry Service Board. 1: \Building\Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB) Building Permit Application Checklist � _ 3 � 0 c oi i c0 F ` c 54 ( r F� S H N O E i '-,::.,-",'.7-7 One- and Two - Family Dwelling , ' Received City of Tigard Permit Nn.: � r v 13125 SW H all Blvd., Tigard, OR 97223 DateBy: C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: IIt_AIZI)' 24- Hour Inspection Line: 503.639.4175 El Electrical ❑Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ other: `, f r Y4, - ,, ; .. i .� ...i-..�r.. °. NS. . <� .{�. .,.-.,.,r'...,�tr } .. ' , T.. . , . .. . ., 'a-. -- ).. , . ,�' 1� ` f v ` '7` ��'� .�Y. 17s.�.�11i. fit i 1- 11 ,,ti l �� t)� y / � *; �� Tf�r For_,�o�� � i��c�is f�>zr. it>I ui =izri� F�ii�i �� i � � f � Y 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. ❑ El ❑ 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. .. ::�UR[SDIC [ LUNf \li SPI C II ICS �_; � .. li... � -'"2..-';' _ . . ,� �sr' 1 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 1 1" or 1 1" 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. ❑ i ❑ ❑ 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.doc 03/21/06 440- 4613T(1 l /02 /COM /WEB) Electrical Permit Application ,% y:-1 tll .fell I ICI.tuti1 O��1 _` . 4 f, ,. City of Tigard � { 1 � a 1 I i 1 . ' rl ig � 1-". . i hd Date/B • �f III ° 13125 SW Hall Blvd., Tigard, OR 97223 " " Pl Review MMIIMIEII i 11 Other Permit: P hone: 503.63 F ax: 503.598.19 Date/B : I 1 c , 'dt Inspection Line: 503.639.4175 PR 0 7 201 Date Read /B Juris: El See Page 2 for Ready /By: Internet: www.tigard- or.gov Notified/Method: Supplemental Information n i'i'i ; r' . r' i I rt ft tD n TYPE OF WO ", '`� �t PLAN REVIEW • . A e\lkin, f iviClr7 ` • :A . w raUon/replac x :bier sn ° "' .- ement El New construction [ Addition /alte Please check all that apply (submit 2 sets of plans w /items checked below): � ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: < . 100HP or more. occupancy. \ l i �2 �° :J ! �� ` ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: eT l t '> Z CI ) 7 z- `'"I ❑ Health -care facilities. ❑ Supply voltage for more than rrr �„ - -_ "' ❑ 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. R. or less 168.54 4 Ea. add'I 500 sq. ft or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 67.84 2 G" 1 N \ Ski r�� l� j--N f ‘ Skh--48-T 64 residential (with above sq. R.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 , IJ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 C 401 amps to 600 amps 200.34 2 Name: CI C"-- Gift -c' S L"--"'"' pi 601 amps to 1,000 amps 301.04 2 Address: i to S 3 3 W 1 ''' i'•-• 1- \ Over 1,000 amps or volts 552.26 2 t Temporary services or feeders installation, alteration, and /or City /State /ZIP: "1 ---- � �� Z - relocation Phone: (5c, ( 3 9 Z Ce 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 1 own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, an 701. 401 amps to 599 amps 168.54 2 I Branch circuits - new, alteration, or ex tension, per panel Owner signature: �'�'` s- ( Date: L 2 1 1° A. Fee for branch circuits with ❑ APP CANT I above service or feeder fee, ❑ CONTACT.'PERSON each branch circuit 7.42 2 Business name: B. Fee for branch circuits without service or feeder fee, first Contact name: branch circuit 1I 56.18 (� 2 Each add'I branch circuit - 7.42 2.1, 2 Address: Miscellaneous (service or feeder not included) manufactured Each City /State /ZIP: dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 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: & t - s d — fl — panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (I hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (/2 hr min) CCB Lic.: Electrical Lic.: 5 tai{ 3n Suprv. Lic.: ELECTRICAL PERMIT 'FEES Subtotal: 65,8__G Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): 10, 5C C TOTAL PERMIT FEE: 9' t ( 6 Authorized signature: This permit application expires if a permit is not obtained within 180 " 5 ,-,............d. days after it has been accepted as complete. Print name: Date: Z b t 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 WORK ONLY: Fee for all residential systems combined .. $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK :ONLY: . Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L\ Building \Permits\ELC- PermitApp.doc 10/01/09 • Mechanical Permit Application `, 1 1€ "0` W` ' ' , xF 4 ; ,,y,; s _3 , e ! " , Received City of Tigard iii �` t Permit No.; 114 a It �, { a Date/By: 13125 SW Hall Blvd., Tigard, OR 972 ,` }/ Plan Review r • Phone: 503.639.4171 Fax: 503.598.9960 r- Other Permit D ateBy: , : I I ( ; \ Intl` Inspection Line: 503.639.4175 Date Ready/By: Jud H y: See Page 2 for Internet: www.tigard- or.gov APR 0 7 2010 Notified/Method: Supplemental Information nrr'v !'s• ^. TIC_ADPI TYPE .OF ORK III, f11t /I 1f t ,! ' • COMMERCIAL •FEE* SCHEDULE USE CHECKLIST " at Mechanical permit fees* are based on the value of the work ❑ New construction [Addition /alteration/replacac ement 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* A I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ' For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: I � ( > 5 r › I J r� t , Air conditioning 1 (requires site plan showing placement) 46.75 "' Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: � a \ R [ �2 . L -� ] Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: qtr Z N u -A - k)'-4Q4kfill Duct work 1 23.32 Hydronic hot water system 23.32 • C v 5 p. r �\ ;' ■'-' �ti ti`Ay i 1 L? \'"6 . --C-0 Residential boiler (radiator or ✓ 1 `,.� hydronic) 23.32 " \ Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances • . DESCRIPTION OF WORK Water heater 23.32 ' Gas \� Gas fireplace 33.39 1 (a` i � ' 1-- 5 '-�:. 't t i :J L Flue vent for water heater or gas • _ fireplace 23.32 1 Q,---0 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ' 'n_ PROPERTY OWNER - • . ❑ TENANT Chimney /liner /flue /vent 23.32 Other: . 23.32 Name: S c-S-" C c,-(- `IS •.x..a0 Environmental exhaust and ventilation Range hood/other kitchen Address: L L S �� equipment 33.39 City /State /ZIP: _— j cb (t. Ch i? 7-2---9) Clothes dryer exhaust 33.39 Single -duct exhaust throom Phone: (5 )5 („ s 3 '21 ((, Fax: ( ) toilet compartments, utility rooms) 1 23.32 7 ?,,Z..-- ❑ 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 • Z- 3 r Business name: wr. Clothes dryer (gas) r i�� -� '1 � 1 .> Other: , V �� 4" II, >3 Address: "? - MECHANICAL PERMIT *. . City /State /ZIP: r.-- Pz---.. 1.7 z L� Subtotal 2 a Minimum permit fee ($90.00) ( ( Phone: (c Lii 2-1 1. 7 (k Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 16, O TOTAL PERMIT FEE (-QQ,F;Q This permit application expires if a permit is not obtained within 180 . Authorized signature: days after it has been accepted as complete. Print name: LTA ' .- ly- 1'.— 1 .k Date: 9 7 1 I 10 ` Fee methodology set by Tri- County Building Industry Service Board I: \ Building \Permits \MEC- PermitApp.doc 10/01/09 440- 4617 /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 f , " Plumbing Permit Application 7 R Build Building Fixtures C - % rt , 1 1 :d I- < &y " I( R 1 !0111(1 tJ ( � I1 �„r ,.�Y i ing li ? 1 !J ,, . vv , - '' c �i.:� M aw 4 .a. , te w9 ,.. - ±e i s.. >.,-- City Of Tigard ►9 Received permit No.: 114 a 131 SW Hall Blvd., Tigard, OR 9 0 1 ZOO Date/By: 5/ U�U d Plan Review Other Permit No.: P hone: 503.639.4171 Fax: 503.598.1960 Date/By: Inspection Line: 503.639.4175 .r y oF TiGARD Date Ready/By: Juris: Vi See Page 2 for . - Internet: www.tigard- or.gov ttt 1..,•1N,,., i.11,t)tr`l("1i',.3 Notified/Method: Supplemental Information • 1 i9i4 ry •ii'J td ewr v .v. .. -.. TYPE OF WORK FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total [3 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 p 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: 1 C C., 3 S 'vS 1 aril` l Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: 1 s\ _.4y-61 �L".-- 1 1 z z Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: ` - Manufactured home utilities 50.03 Cross street/directions to job site: ^-:or .- `I C. J V, D ' - V -1 '\ Manholes 18.76 S ..,....... tk •I-:. .,,_`, ¢: 17c i _0. \ Rain drain connector 18.76 e_ V 't' o c i DI-)... P 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' valve 12.51 Clothes washer 25.02 r w. i .."-‘ r->--% \ c `J \ S N` - 1 - Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ELPROPERTY 'OWNER - I ❑ TENANT Expansion tank 12.51 Name: 5.- t;--,.�c� Fixture/sewer cap 25.02 �� Floor drain/floor sink/hub 25.02 Address: *�` P 1 Zs __Ls 5 w cl © 1 Garbage disposal 25.02 City /State /ZIP: t 3 (,_ Qom- 1 1 2_ 2-' f Hose bib 25.02 Phone: (5 o3) � c 3 2'-1 Co 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 /basi t�Qavatory 1 25.02 26. City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51 12,s I E -mail: Urinal 25.02 CONTRACTOR Water closet I 25.02 2./5 ,C)2._. Water heater 37.52 Business name: p-tN I.r tLiL Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal C Z, Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 � 1, q , 5 -- CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) -) 7C Authorized signature: i at _" r TOTAL PERMIT FEE J 1 t 2C' s�� t v ,..,4 Date: t-t 1 O This permit application expires it a permit is not obtained within 180 days Print name: ' S , `/ atter it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \ Perm its\PLMU- Permit App .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 Qty. . Fee (ea) Total Square Footage: Permit Fee: Footing drain - 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 Valuation Permit Fee: • . Storm &Rain Drain - 1st 100' 62.54 $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 $ I.52 for -Other Inspection's 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/Shower El New exterior plumbing site utilities for any complex structure Bath - ower Tub /S as defined in OAR918- 780 -0040. W eS rtlpool ❑ Medical gas and vacuum systems for health care facilities. Car Wash -Each Drive Stall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator El 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.or''Riser 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: I:\ Building \Permits\PLMF - PermitApp.doc 2 2- D' ff� i .' `' iii‘ L L ' 0 w• i , # f \ r..itz P CITAy//� / ` ,a .. , �JroVed . {.�.�di.r.d.tlbb6e6d..se.e [ � 4) 5`�e Co , itionaliy Approved [ S ee . to: Follow......... ..... [ 1 4 .. A , hed . ... .... Permit i bell 4. V!. a ° &�!'. G 1 Ad ' • ss 7 �'�"' By: `:'. 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IN PLACE TktAT APPEAR TO OE PROPERTY CORNERS • MSS DECLARaTION iS k4a.DE AT TNE REQUEST. AND FOR /HE EXCUJOIVE USE. QF PIE ABOVE NAMED CLIEW, AND 18 NOT TO BE MED FOR FLMME IMP) VMENT& UaND DIVISION OR sOUNDARY LOCATION. PROPERIY SUBJECT TO EASEkAl:NIS OF RECORD. suRVEYOR: Wo...10.4.. G • IC) OVN'''`"'"'r LS. ACCOUNT NAME: ' frovrite port - . . . • ---