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Permit
Ir CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2010 -00155 1 3125 SW, Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/28/2010 T IC'ARD Parcel: 1S134DC11300 • Jurisdiction: Tigard Site address: 11530 SW GALLO AVE Subdivision: CASCADIAN PLACE Lot: 2 Project: Mercer Project Description: 356 SF sunroom addition. 12/22/10. reprint to add (7) additional branch circuits and (1) hr of electrical inspection time._ BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 356 sf Basement: 0 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: No Total: 356 sf Value: $125,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: Y Hoods: 1 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: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'l 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 11 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: ALT SF VB R -3 356 Owner: Contractor: MERCER, SCOTT D & VALERIE G OLSON & JONES CONSTRUCTION INC Required Items and Reports (Conditions) 11530 SW GALLO AVE PO BOX 19563 PORTLAND, OR 97223 TIGARD, OR 97280 PHONE: PHONE: 503- 244 -7467 FAX: 503- 244 -6791 Total Fees: $3,279.32 This per ' ' ' . ued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and =ll other applicable law. All work will be ••ne in accordan ; with approved plans. This permit will expire if work is not started within 180 days of issuance, or ! work is s .ended for more the 180 d- s. ATTENTION: Oreg. • I. require ou to follow the rules adopted by the Oregon Utility Notification Cente'. Those As s are set forth in OAR 52- 001 -0010 through OAR 9.01 -00 may obtain a copy of the rules or direct questions to OUNC by calling 503.232,,•: '.r 1.800., ' - ssued By: _ _ Permittee Signature: ♦ AIL AllIk `' Call 503.639.4175 by 7:00 a.m. for the next available inspectio +ate. This permit card shall be kept in a conspicuous place on the job site unti, • . mpletion of the project. Approved plans are required on the job site at the time of - ach inspection. CITY OF TIGARD MASTER PERMIT III e • COMMUNITY DEVELOPMENT Permit #: MST2010 -00155 T 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010 Parcel: 1S134DC11300 Jurisdiction: Tigard Site address: 11530 SW GALLO AVE Subdivision: CASCADIAN PLACE Lot: 2 Project: Mercer Project Description: 356 SF sunroom addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First 356 sf Basement: 0 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: NO Total: sf Value: $125,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 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: Y Hoods: 1 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 add'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/0 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) MERCER, SCOTT D & VALERIE G OLSON & JONES CONSTRUCTION INC 11530 SW GALLO AVE PO BOX 19563 PORTLAND, OR 97223 TIGARD, OR 97280 PHONE: PHONE: 503- 244 -7467 FAX: 503 - 244 -6791 Total Fees: $3,146.95 This perm' ' issued subje o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a d all other applicable law. All work will be do in accordance with ap• •ved plans. This permit will expire if work is not started within 180 days of issuance, ir if work is suspended for more the 180 day . ATTENTION: Oregon law - • . e you to follow the rules adopted by the Oregon Utility Notification Ce • t r. Those rule set forth in OAR 9 - 001 -0010 through OAR 952 -00 .100. Yo = y obtain a copy of the rules or direct questions to OUNC by calling 503.246 • • .9 or 1.800.332. . - Issued By: — �� i/ fL �, � Permittee Signature: r1I 1` ( J Building Permit Application Residential , Et IOR Orrlcl: lisl•: ONt.1 City of Tigard Date/B ed 13125 SW HaII Blvd., Tigard, OR 97223 ` , ®3 ( Q� 1 plan Review �r '� C ' Phone: 503.639.4171 Fax: 503.598.1960 DateB . Other Permit: Ti ci A it D Inspection Line: 503.639.4175 TIG , ' El See Page 2 for Internet: www.tigard - or.gov CITY Q p w , Supplemental Information gUD .WING DIVI 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 T4 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application r9✓' �1- and 2- family dwelling El Commercial/industrial Valuation: $12.5 El Accessory building El Multi-family Number of bedrooms: ❑ Master builder vi Other: S V• h roc yyn Number of bathrooms: KJ JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 1 530 v ` S l CI a t l O Av P.hUe New dwelling area: square feet City /State /ZIP: ` sa r t o � 9 - Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Mercer Su in ( o IA A Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: ,156 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: CQC, coz to n',� Lot no.: 2 Permit fees* are based on the value of the work performed. Tax map /parcel no.: 1&J C TNV► IS i 3 41) C 'Vex L# 1300 Indicate qup the value materials, labor, to the ead, and dollar) profit of all � � equipment, materials, labor, overhead, and the profit f for the DESCRIPTION OF WORK work indicated on this application. 11, ,r ► I `' Valuation: $ m • 0. V r • • v a.► Ire "Q t(ev ( `ov 1 / P x` • Sl S /J 1 Existing building area: square feet `r Tx t0.WLt New building area: square feet a PROPERTY OWNER I ❑ TENANT Number of stories: Name: cr k-k- \ V ej d er v\ Type of construction: Address: t t 530 ‚3L ( co IC AV e u e Occupancy groups: V Q a City /State /ZIP: , r 1 ,rc3. 00. 'Luz, l Existing: Phone: (G 1 59 , 6 _ �o'� 3 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: O\ Son t be S /1 �� ruc4,cc,n `/ - BUILDING PERMIT FEES* Address: �.O �� �X r v15 � 3 n (Please refer to fee schedule) City /State /ZIP: I) prA , 1 l� �9Z 50 Structural plan review fee (or deposit): � ) 2 t. a .." L1(,�1 Fax: (CD3 ZA tk� (0.1q FLS plan review fee (if applicable): Phone: 3� o r 7/ y / � Total fees due upon application: 377 a 4 ./ CCB lic.: 10 Amount received: Authorized signature: 111.17 - 4 This permit application expires if a permit is not obtained MVO' O within 180 days after it has been accepted as complete. Print name: S, V 1 �Q Q f Date: * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(1 I /02/COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FoR O1. usi.: ()NI.) City of Tigard Received Permit No.: 11114 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By: C ' Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing 0 Mechanical 1 It � ) Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE. REQUIRED FOR PLAN REVIEW ' " es 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. 1 I Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if t . ❑ ❑ 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. 1 2 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size NI ❑ ❑ 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 - [K, ❑ ❑ 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 - LL ❑ ❑ 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 (A ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 1 ❑ ❑ 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 gi ❑ ❑ 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 J ❑ ❑ 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 pi. ❑ ❑ architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review. 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". EL ❑ ❑ A 4 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. . • l: Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440-4613T(I1 /02/COM/WEB) f Electrical Permit Application l OR (►FFICI: Hsi.: ()iil.l' City of Tigard Receiv a �. / 8 1 . 13125 SW Hall Blvd., Tigard, OR 972 r CE�ED Plan Review IS Phone: 503.639.4171 Fax: 503.598. }9' DateB : Other Permit: 11 ( . ` 1z i ) [ Inspection Line: 503.639.4175 Date Ready /By: ® See Page 2 for Internet: www.tigard SEp 0 3 l � Notified/Method: Supplemental Information TYPE OF WOR 4 oF TIGIARD PLAN REVIEW ❑ New construction �Addition/altera i�r�1, VISIO Please check all that apply (submit a 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: 5 A l ❑ 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 - ", "I - ", r IOOHP or more. occupancy. Job no.: Job site address: ,1 3 S . `V • � C.(I io 0 Six or more residential units. p ❑ Recreational vehicle arks. City /State /ZIP: ' ‘' I OR q -722 ' ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: m e{ ' ce f u ,,r- gyp . ❑ Service or feeder 600 amps or more. S V" FEE SCHEDULE Cross street/directions to job site: Description 1 Qt 1 Fee. 1 Total 1 • . New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 168.54 4 Subdivision: at , 4 QC� Lot no.: 2„ Ea. add'I 500 sq. ft. or portion 33.92 I Tax map /parcel no.: Q C T M I S 13 4. DC. rI Q x x+ ` \iOQ Limited energy, residential 67.84 2 DESCRIPTION OF WORK 1 (with above sq. ft.) 4-614 1 it N t4 Limited energy, multi - family 67.84 2 2 3 I -2 S V A ece-4- residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation e VP J0. -,--0- S �/l cC.�A � kekr- _. 200 amps or less 100.70 2 OLPROPERTY t JWNER ❑ NANT 201 amps to 400 amps 133.56 2 Name: j,� 401 amps to 600 amps 200.34 2 leak f a IQ`�� Q 1 V • 1 C 601 amps to 1,000 amps 301.04 2 Address: 15 '50 5,uii, G z h Ue , Over 1,000 amps or volts 552.26 2 City/State /ZIP: �t 12 Temporary services or feeders installation, alteration, and/or �� �v relocation 1 _4,, Phone: (503 J 13 ' Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 extension, er panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 56.18 2 first branch circuit Address: Each add'I branch circuit 7.42 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 ,E,mail: _ Pump or irrigation circle 67.84 2 . ti '' COlintACI`44 Sign or outline lighting 67.84 2 • r Business name: � � / Signal circuit(s) or limited- ,4 .4ede ism 1474;4 �" c energy panel, alteration, or Ate r j- 62 �� J L yP F f J di' extension. Describe: Page 2 2 City/Statc/Z1.P: JM L., , ett 9 7l el 5 Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: (sal ) 5 0 J3 /p F ( ) ,t�'IK Investigation per hour (I hr min) 66.25 - CCB Lic.: /tt 77 Electrical Lic.: G' /S Suprv. Lic.: 5.52 Industrial plant per hour 78.18 _a_ Eft L >. o a ELECTRICAL PERMIT FEES Subtotal: . Print ctilic 0411 — ° fl .I Plan review (25% of permit fee): State surcharge (12% of permit fee): Pratt mutiIn: 13451st: TOTAL PERMIT FEE: ` I i "V e , ^A o � �� 9 1 13 1 This permit application expires if a permit is not obtained within 180 Print name: • `W i v 1 '``+l ` Date: days after it has been accepted as complete, ' Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440-4615T(I1 /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* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ 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 ❑ 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 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 Mechanical Permit Application FOR OFFICE f Si: ONLY City of Tigard RECEINT6 I'' • eceived Date/By: PennitNo.: mSret l /) () 15 . 0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 O 3 7 61 I Date/By: Other Permit: Ti GA I. �� Inspection Line: 503.639.4175 L ' Date Ready/By: kris: ® See Page 2 for Internet: www.tigard- or.gov ' ° t'otified/Method: Supplemental Information CI'T'Y oV 1" 1ING TYPE OF WORK gU1LL1.— v1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ID New construction IX Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Kt I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder 17 _ Other:S r CDOW1 Description 1 Qty. 1 Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling 1 `A Air conditioning Job site address: % % 530 S , . x.4L 0 NV e y , V e, (requires site plan showing placement) 46.75 City /State /ZIP: ` Furnace 100,000 BTU (ducts/vents) 46.75 T \ say- \ ZZ Fumace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: J Project name: rn e C a' r S VVCOOW1 Heat pump 10- I 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: C OSr, : f trace. I Lot no.: Z G'�' �' S 1 4 Is C I 4 t ` 73 O Other: 23.32 Tax map/parcel no.: QK LDT ` Q Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 I u 2 \ 0 1 Gas fireplace 33.39 1 , I v "' 3 X , .- So N t OVA 1 - POL} Flue vent for water heater or gas �`` `'' N + fireplace 23.32 e A P V � � ? 4 - V X &V C Z )L g S ►e - C - sz , 1M I ki Log lighter (gas) 23.32 V W v Wood/pellet stove 33.39 Wood fireplace/insert , 23.32 KPROPERT ` O WNER I ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: G c� \ Other: q a.\ e.11•t e\ Y\Q rTce( Environmental exhaust and ventilation Address: 1 Range hood/other kitchen 1 \� 7 40 5 x l. G a t 0 oNvev\�� equipment 33.39 City /State /ZIP: T1 0 q '7 Z Z 3 Clothes dryer exhaust 33.39 ( ! >) \ _ 1 Single-duct exhaust (bathrooms, 1 Phone: Set � "?7� Fax: ( ) toilet l compartments, 1 utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping Contact name: 514.15 for first four; 54.03 for each additional Address: Fumace, etc. - Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) 1 Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue C Clothes dryer (gas) Business name: t coy , A , s ( 4 b ,„, j 6 f�y6 . J " ` Other: Address: t1) ©X \C7( / (3 MECHANICAL PERMIT FEES* City /State /ZIP: j 1 � J � '7 G� Subtotal `� ' 1 / �) Minimum permit fee ($90.00) [ Phone: (1i ) 2 U . I �"7 I Fax :503) . T 9 V f q 1 Plan review (25% of permit fee) CCB lic.: �_ 5 40b I II ` J State surcharge (12% of permit fee) v 1 ; P TOTAL PERMIT FEE Authorized si at '� This permit application expires if a permit is not obtained within 180 1 days after it has been accepted as complete. Print name: ElIP Q Q ne M Date © ' • Fee methodology set by Tri County Building Industry Service Board I:\ Building \Permits'MEC- PennitApp.doc 10 /01/09 440 -4617T (1I /07/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. I:\ Bui lding\Permits\MEC- PermitApp.doc 10/01/09 2 Electrical Permit Applicatio FOR OFFICE USE ONLY City of Tigard kECEIVED Date /B : /.2 �� T� Permit No.: t ° 13125 SW W Hall Blvd., Tigard, OR 97223 / I�.t T .2 D a - Op / 5 g Pl Review ' 11 .. ' Phone: 503.639.4171 Fax: 503.598.1 C 2 2 i Date/B : Other Permit: I' I C. A It D Inspection Line: 503.639.4175 Date Ready/By: Juris: VI See Page 2 for Internet: www.tigard- or.gov f.r OF TIGARD Notified/Method: Supplemental Information TYPE OF Wr,(�ING DIMS!` '`' PLAN REVIEW ❑ New construction ,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 El 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 ", Job no.: Job site address: 100HP or more. occupancy. ❑ 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 I Qty. I Fee. I Total I * 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) j4( �� /� // Limited energy, multi - family 75.00 2 ✓.., / /.' ;[. 1 / 4o .v / 41;G. 0t 42/ fL residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation h • as ..G . . 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ 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 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 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 extension, 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 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 CONTRACTOR Signal circuit(s) or limited - energy �� / panel, alteration, or extension. Page 2 2 Business name: /Jt.� roLu .G /� - T r •G Each additional inspection over allowable in any of the above Address: /,/77 f 11,,,//.,,,, C/ , / Additional inspection (1 hr min) / 66.25/ hr 6 6, 25 Investigation (1 hr min) 66.25/ hr City /State /ZIP: / �� G T `a 7 7 O� Industrial plant (1 hr min) 78.18/ hr Phone: (5 e u) ,S 8d ./ f/Q Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%z hr min) CCB Lic.: /199 7 Electrical Lic.: G 6 /5 Suprv. Lic.: 5,5 . 1 ELECTRICAL PERMIT FEES. q Suprv. Electrician signature, required: Subtotal: 1 1 3 n �C l Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): 1q * ( � TOTAL PERMIT FEE: ( a . 3 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 of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1 /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 n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system • • (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n 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 07/01/10