Loading...
Permit CITY OF TIGARD MASTER PERMIT :'= s COMMUNITY DEVELOPMENT Permit St: MST2008 -00010 T 1 G 'A RID 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2010 Parcel: 2S112CCO5900 Jurisdiction: TIG Site address: 15954 SW 81ST CT Subdivision: Lot: Project: SCHOLZ Project Description: Convert open space above living room to bedroom. Permit extended for additional 30 days . MAV - must be issued by August 25th 2010 BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: sf Basement: sf Left: Parking Spaces: Height: 25 Bathrooms: Second: 213 sf Garage: sf Front: Smoke Dwelling Units: Third: sf Right: Detectors: Yes Total: sf Value: $20,232.87 Rear: PLUMBING Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs/Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: Clothes Dryers: Heat Pump: N Hoods: Other Units: Furn <100K: Vents: 1 Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 0 -200 amp: W/ Svc or Fdr: Ea addl 500 sf: 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea addl 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) MARK SCHOLZ Q cv xJ t f , 15954 SW 81ST CT. TIGARD, OR 97224 PHONE: 503 -703 -0618 PHONE: FAX: Total Fees: $615.96 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe ded for more the 180 days. AT - 'TION: • -!on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rul =• are set fort • •AR 952 -00 r 010 through OAR • • 2 • : ' 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or, . :0r=• 3 344. di //� ` issue By: k Permlttee Signature: X i�Y ./ /\ / Building Permit Appl ?5) s Cl"-- Residential FOR OFFICE,USE ONLI RECEIVED Received City of Tigard DateByZliaio$ 3 Permit No -�,� �nry�O a 13125 SW Hall Blvd., Tigard, O 2 Plan Revi " IN : _ Phone: 503.639.4171 Fax: 501PP1 0�+ 2008 Date/sy: . ( 2 / Velr0� Other Permit: T I G A 11� Inspection Line: 503.639.4175 Date Ready /By: ruri ® See Page 2 for Internet: www.tigard- or.go OF TIGARD Notified/Method: /� 7/(g Supplemental Information BUILDING DIVISION tvrn ✓ J / W / ✓il,,v mum): -e_ - • " - .. - 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 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ,, ' • CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ / z4/0.00 l- and 2- family dwelling ❑ Commercial/industrial / ❑ Accessory building ❑ Multi - family Number of bedrooms: 0 ❑ Master builder 0 Other: Number of bathrooms: ---e} : JOB SITE INFORMATION AND LOCATION'- Total number of floors: / . 0 Job site address: 1515-9 5 8) Ca H v_ t New dwelling area: . I q Z square feet City /State /ZIP: `1- -,3Aid O O. `7' ezi Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: SC t iz Rurr+e &,1 Covered porch area: square feet Cross street/directions to job site: 1),,,,,), / } ,� d f y C f. Deck area: square feet Other structure area: ------ square feet Aql'Ali -(aV 045 REQUIRED COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the ' ,` • = - DESCRIPTION OF • WORK. � • work indicated on this application. Valuation: $ lrol on 0� bt✓droor►, PA iv ofe-n spa rc c,.bu e e/ slin5 1 y ! ' ?j room Existing building area: square feet A s/ 1 a e...e... -0.-510O New building area: square feet ^ PROPERTY OWNER , I` • ., . ❑ TENANT Number of stories: Name: / /1/1 r k 5 I Z Type of construction: Address: 159 Sy 6 tiv $) 4 2' Cov fr Occupancy groups: City /State /ZIP: 1-1-,c4.,...). 0 97Z-L L/ Existing: Phone: ( 503) 703-06 /8 3 Fax: (5 ) 33& - 72 31 New: .. APPLICANT • . • • ,CONTACT : PERSON - • ., ... NOTICE .. , . . Business name: All contractors and subcontractors are required to be Contact name: S _ I licensed with the Oregon Construction Contractors Board ct,,n.e A 5 9/9ovC 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: (50 703 -06 /9 Fax: : ( ) f E-mail: yY► ar f 4 , S C. h O I L € ,, „„i, / . C oih CONTRACTOR Business name: 0 M. e"-- V BUILD PERMIT FEES* Address: r " • (Please refer to fee schedule) City /State /ZIP: Structural plan review fee (or deposit): Phone: ( ) ( ) FLS plan review fee (if applicable): Fax: CCB lic.: Total fees due upon application: Amount received: f idiD. 30 Authorized signature:��� This permit application expires if s permit is not obtained within 180 days after it has been accepted as complete. Print name: a , - /,c, hi. c4 s- Date: L1 I 1.17-00 $ * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling `" 4 `� , . `: '� E - ' r i ; h � ` * �' u _ - FOR OFF tUSE •O NLY r1� '� .1: q City of Tigard . Received Permit No.: Date/By: : 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: : r C Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical i- i.-,- G . K - Internet: www.tigard- or.gov ❑ Other: TH VT, OLLOWINUITEMS E UEREDf`FOR PLANKREVIEW .i' - r es N o , — Om 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 Oregon and shall be shown to be applicable to the •ro'ect under review. `` IURIS IC ON A L SI ' L CIIICS ..;. a ,;:., * ;,' 1 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include 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. IABuilding 03 /21/06 440- 4613T(11 /02/COM/WEB) ` .�.j' tsf�K' ?,, E .ib 'G^ , ire{ " .7. �i � Mechanical Permit Application ' _ , k : Y -: FOR OFFICE; USE ONL 'City of Tigard '" ® M I N I - Received ( E® Date/By: �� • // / a 13125 SW Hall Blvd., Tigard, o- I , Plan Review C Phone: 503.639.4171 Fax: 5:3. ' � :. 9.1 Date/By: Other Permit: T 1 G A It 1� Inspection Line: 503.639.417 FEB 1 2 2008 Date Ready/By: Juris: Internet: www.ti ardor. o v S See Page 2 for g g Notified/Method: upplemental Information ,,��^^����/ ) TIGARD TYPE DIVISION COMMERCIAL 'FEE* SCHEDULE —`USE CHECKLIST j�' 9F Wb ❑ New construction gAdditibinTalt ` er ra ation/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY" OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT /SYSTEMS FEES* 01- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total JOB SITE. INFORMATION AND .LOCATION, Heating/cooling Job site address: 5 3 w g) i-t C'aN�- Air conditioning heat pump (requires site plan shown g placement) 14.00 City /State /ZIP: `/' p r d 0 ( 97 1-2, L( Furnace 100,000 BTU ( ducts/vents) 14.00 Fumace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: ✓ Project name: nn S e kol ►SG►rio d q Gas heat pump 14.00 Cross street/directions to job site: Duct work / 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 • Tax map /parcel no.: Other fuel appliances DESCRIPTION. OF ,WORK • " . -- ' • . Water heater 10.00 Gas fireplace 10.00 BzU -roan 4 dt'1i fe) arm -s f1que 4 bry t e4(/Si7A Flue vent for water heater or gas J fireplace 10.00 I An f`cos►l • Log lighter . (gas) 10.00 f in_ dl DC.tt; W Wood/pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 � l � l Other: 10.00 iii PROPERTY OWNER ❑TENANT Name: /Y I arl, S 1 A L Environmental exhaust and ventilation Range hood/other kitchen Address: 15 Sif .5w 8 Lt. Co uir equipment 10.00 City /State /ZIP: •7 ,n /d , OR 97 1-1. 11 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (5 7Ct —O/ /g Fax: (513) 33 -723"/ toilet compartments, utility rooms) 6.80 - . APPLICANT; , ❑ CONTACT PERSON -., . . . Attic /crawlspace fans 10.00 Other: 10.00 Business name: // Fuel piping Contact name: ../1/141 C. a 5 S b o +,. ( $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: mu v- fr... ,S G4C Iv e, j ai i - i ocr Range CONTRACTOR - Barbecue c Clothes dryer (gas) Business name: / , (/t �� Other: Address: MECHANICAL PERMIT FEES* . City /State /ZIP: Subtotal Minimum permit fee ($72.50) - 3-2.5 - 0 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: This p ermit a expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 04 4 r A. 4/ - S ho% Date: Z 1) . ) L Dog • Fee methodology set by Tri- County Building Industry Service Board I: \Building\Permits\MEC- PermitApp.doc 01/19 /07 440- 4617T(11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: `Total Valuations. Permit $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • 1:\Building\Permits\MEC- PermitApp.doc 01/19/07 2 Electrical Permit Application ' S' . f , � } A " -.• FOR OFFICE' USE ;(: • . _ :y',:.;42:,.• C of Tigard iA '"Is ateBy: Permit Norn (d0 /0 13125 SW Hall Blvd., Tigard, OR 972 �, IV E Plan Review Phone: 503.639.4171 Fax: 503.598. 6 • DatDate/By: Other Permit: T 1 G n u. Inspection Line: ine: 50303 .639.4175 Date Ready/By: Juris. El See Page 2 for Internet: www.tigard FEB 12 ZO O Notified/Method: Supplemental Information TYP of wo>T O F TI GARD PLAN REVIEW . ❑ New construction Addition /alter Q � rr glg )D IU I SIGN Please check all that apply (submit 2 sets of plans w /items checked below): tJ t.L� 11 V ❑ 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 0 Accessory building amps for all other installations. buildings. Multi- family 0 Master builder 0 Other: 0 pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION O Emergency system. larger separately derived system. CO34,-t- ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 “, Job no.: Job site address: 1.sgsy 3 W Uj s r' ❑ I OOHP or more. occupancy. Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 7 A/ d 012.. q7 z , Z y ❑ Health - care facilities. ❑Hazardous locations. ❑Supply voltage for more than 600 volts nominal. Suite/bldg. /apt. no.: Project name: t- g o ❑ Service or feeder 600 amps or more. FEE SCHEDULE'' ' • Cross street/directions to job site: buOkOty►1 /'7 i* h, $oid 51 Description 1 Qty 1 Fee- I Total 1 • 1 �` l!-/ � r New residential single- or multi- family dwelling unit. p d o 4, G I Co „-t Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 . DESCRIPTION OF WORK . (with above sq. ft.) Room \ Limited energy, multi - family 75.00 2 1`oom ar, C „4,- ,„o•+. i frtio O�ey ,,,,ace ,,ace v residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 6 S ) i.” 1 fi/ A J to rte 200 amps or less 80.30 2 • PROPERTY OWNER, • ❑ TENANT - 201 amps to 400 amps 106.85 2 Name: I v l 4. )4 5C t o I 7-- 401 amps to 600 amps 160.60 2 r 601 amps to 1,000 amps 240.60 2 Address: I 5 5s 5 (&) 8/ �- C ©v. / t . Over 1,000 amps or volts 454.65 • 2 City/State /ZIP: 1 C1 Tat Temporary services or feeders installation, alteration, and/or relocation Phone: ( 5 703-06 / 9 Fax: (5C' 3) 336 - 7 2 34 200 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 . APPLICANT - -. ❑ CONTACT. PERSON.' above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: !j a 5 k./lo vC without service or feeder fee, / 46.85 2 G! C first branch circuit 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: N1 c,, -}c■ SC hotz e_ 3:410, Cc n Pump or irrigation circle 53.40 2 CONTRACTOR . . , , Sign or outline lighting 53.40 2 Business name: Q (, Jl/ ) `\ v _/C�+ (_c n Signal circuit(s) or limited - \ energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 . • ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: %j ,a) Print name: Date: • Plan review (25% of permit fee): 6.`1- State surcharge (12% of permit fee): Authorized signature: L�� TOTAL PERMIT FEE: 5 - q> N � This permit application expires if a permit is not obtained ( within 180 Print name: 1/4414. 4) . 5c AdZ Z Date: l z x008 days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doc 05 /23/06 440- 4615T(1l /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: riftgli*StraLl*TeiatiSTEVT 7 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: rOCOMgatt I. WORK ONLYc7 -7 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 _ a Building Division One & Two - Family Dwelling T I G A R D Fees Checklist PERMIT INFORMATION: Permit #: ry 1 + a - 00":1!,'I Plan #: Date: .24 ,t. 09 Site Address: /595 �: 8/ '" Cope+ Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: '"'; e Setbacks: Front: Rear: Left: Right: Class of Work: ' I 4 I. t Stories: First Floor: Type of Use: ,s1, Height: ;; ' Second Floor: Construction: j `1 .- :, Floor Load: 50 pj.P Third Floor: Occupancy Group: R - 3 Dwelling Units: Bonus Room: . / 3 0 Valuation: 4 ,d ,) ,2 3 r Bedrooms: Total Floors: Bathrooms: Basement: Decks: Garage: Porches: Other: FEES: . Description: Fee Amount: Amount Paid: Balance Due: Plan Check: Building: ,f / 7 g/. - ZS ,0 /Co. 30 , j` /4/ O B Extra Set: ..444 N,q Permit: Building: j/ .24g', k 2/ 2g, 2 Tax: 1 32. // ,0 ,.. I/ Metro CET: ,'ji'. 4/4 Mechanical: iY 7.2.5o - 4 , S Tax: 1 L . - ?-U 3 . - i C Plumbing: NA /114 Tax: /V4 . i fr Electrical: 1 r 3 , $o 5 �- ., SO Tax: if G . `la 5 7,..9 Low Voltage: / Tax: CDC: CDC Ping. Rev.: CDC LRP Fee: SDC: Parks: TIF Res.: � TIF MT: l/ j Erosion Permit: Erosion CWS: Erosion COT: Water Quality: Water Quantity: SUB - TOTAL,' 6 /5 94 4;' Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: I: \ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 1 PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment /systems) , , Description I Qty. I Fee(ea.) I Total Description I Qty Fee(ea.) Total New 1- & 2 - family dwellings Heating/Cooling (includes 100 ft. for each utility connection) Air conditioning or heat pump* 14.00 SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) 14.00 SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) 17.90 SFR (3) bath 399.00 Gas heat pump 14.00 Each additional bath/kitchen 45.00 • Duct work I 10.00 f0, Q() Rain Drain, single family dwelling 65.25 Hydronic hot water system 14.00 Fire sprinkler - sq. ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric) Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00 , Site Utilities': . . Flue /vent (for any of above) 6.80 Catch basin /area drain 16.60 Repair units 12.15 Drywell /leach line /trench drain 16.60 Other Fuel Appliances Footing drain - l 100' 55.00 Water heater 10.00 Footing drain - each additional 100' 46.40 Gas fireplace 10.00 Manufactured home utilities 110.00 Flue vent (water heater /gas fireplme) 10.00 Manholes 16.60 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Rain drain connector 16.60 Wood fireplace /insert 10.00 Sanitary sewer - 1 100' 55.00 Chimney /liner /flue /vent 10.00 Sanitary sewer - each additional 100' 46.40 Other: 10.00 Storm sewer - 1 100' 55.00 Environmental Exhaust & Ventilation Storm sewer - each additional 100' 46.40 Range hood/other kitchen equipment 10.00 Water service - 1 100' 55.00 Clothes dryer exhaust 10.00 Water service - each additional 100' _ 46.40 Fixture or Item Single duct exhaust Absorption valve 16.60 (bathrooms, toilet compartments, Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer 16.60 Other: 10.00 Fuel Piping Dishwasher 16.60 * *($5.40 for first 4, S1.00 each additional) Drinking fountain 16.60 Furnace, etc. ** Ejectors /sump 16.60 Gas heat pump ** Expansion tank 16.60 Wall /suspended /unit heater ** Fixture /sewer cap 16.60 Water heater ** Floor drain/floor sink/hub 16.60 Fireplace ** Garbage disposal 16.60 Range ** Hose bib 16.60 BBQ ** Ice maker 16.60 Clothes dryer (gas) ** Interceptor /grease trap 16.60 Other: ** Primer 16.60 Total: Roof drain (commercial) 16.60 Mechanical Permit Fees Sink/basin/lavatory 16.60 Subtotal: $ /O .00 Tub /shower /shower pan 16.60 Minimum Permit Fee $72.50 $ Urinal 16.60 Plan Review Fee (25% of Permit Fee) $ Water closet 16.60 State Surcharge (12% of Permit Fee) $ ), 7:1 Water heater 16.60 TOTAL PERMIT FEE $ 11 , 1 Other: Other: Plumbing Pertnit'Fees ELECTRICAL FEES (residential single- or multi - family) Subtotal $ Description Qty. Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less 145.15 4 Plan Review (25% of Permit Fee) $ Ea. add'I 500 sq. ft. or portion 33.40 1 State Surcharge (12% of Permit Fee) $ Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling, service and /or feeder 90.90 2 Electrical Permit Fees . Subtotal: $ 3 . C Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ ( . '/ TOTAL PERMIT FEE $ $ 9.2 1:\ Building \Forms \ResPlanCheckFees doc 01/19/07 Page 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 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. r?/L-k 5Ghe /c Print Name of Perm't Applicant / g // Signatur of = • nt Date Permit #: T49.00 g cooe0 Address: I q 5y 516r t! :���. iur ',,��`, Issued by( Date: Ei This Copy for Permit Offices