Permit QSLp31v* � Q . - c l p f z - C ) ? U 3 X
lAr CITY OF TIGARD MASTER PERMIT
"' .; COMMUNITY DEVELOPMENT Permit #: MST2009 -00127
w z Date Issued: 07/21 /2009
I-TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
,,,,, 74,,� ..,. , Parcel: 1S125DA08300
Jurisdiction: Tigard
Site address: 9070 SW 70TH AVE
Subdivision: KINGS VIEW Lot: 69
Project: Bober
Project Description: Addition of 160 square feet of habitable space. ADDED (3) branch circuits to permit 10/29/09.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 160 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 11 Bathrooms. 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right. 0 Detectors: Yes
Total: sf Value: $16,312.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 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: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =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? 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)
BOBER, DANIEL W & NOEMI FIRST CHOICE CONSTRUCTION INC
9070 SW 70TH AVE 13438 SW CAMPBELL RD
PORTLAND, OR 97223 Hillsboro, OR 97123
PHONE: PHONE: 503- 840 -4564
FAX:
Total Fees: $805.41
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. At 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 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332..22344. _
Issued By: 2-Z.V.- Permittee Signature: n 1 , i
•
CITY OF TIGARD MASTER PERMIT
a COMMUNITY DEVELOPMENT Permit #: MST2009 -00127
.T i G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 1 S125DA08300
Jurisdiction: Tigard
Site address: 9070 SW 70TH AVE
Subdivision: KINGS VIEW Lot: 69
Project: Bober
Project Description: Addition of 160 square feet of habitable space.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 160 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 11 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $16,312.00 Rear: 0
■ PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 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: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
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 addi 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 add9 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)
BOBER, DANIEL W & NOEMI FIRST CHOICE CONSTRUCTION INC
9070 SW 70TH AVE 13438 SW CAMPBELL RD
PORTLAND, OR 97223 Hillsboro, OR ' 97123
PHONE: PHONE: 503- 840 -4564
FAX:
Total Fees: $780.48
This permit i = • =.= ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don= n accordance w 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
day ATTENTION: Orego , requires you to follow the rules adopted by the Oregon Utility Notifica'• Center. Those • - are set forth in OAR
95 - 001 -0010 through OAR 9 - 4' -001 -r 1 % r. You may obtain a copy of the rules or direct questions to OUNC by calling r • .6699 or 1.800. 32.2f 3 .
/ /,
Is ued B y: ' . Per mittee Signature: 1 ./. LIB AL d i
,......._
eil.
u CITY OF TIGARD M5 12. e xi- '61
COMMUNITY DEVELOPMENT
TIG!\ P 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
PECEW
3u1_21 2009
IMPORTANT PERMIT NOTICE CITY (IF 1vIS4G11GAp,D
BDILDNG D1`
Permit #: _ — --
- -- - - -- - --
Date Issued: MST2009 -00127
Parcel:
Site Address: 9070 SW 70 Ave
Subdivision:
Lot:
Jurisdiction:
Zoning:
Project Name:
Description:
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
Daniel Bober Patterson Electric LLC
9070 SW 70 Ave 1834 NE Estate Dr
Tigard OR 97223 Hillsboro, OR 97124
503 -640 -4088 CCB #184801
5C3 � Reg #:
AN INK SIGNATURE IS REQUIRED ON THIS FORM
ta. cagstko c C D, � ���Sctn 3 1JC, S
Signature of Supervising Electrician Name (printed) SUP LIC #
Budding Permit Application
Residential RECEIVED FOIL OFFICI: USE ONLY
City of Tigard Received
U 8 2009 Date/3 : _ ' 4 Permit No.: m y 2 cOQ , oO127
II
• 13125 SW Hall Blvd., Tigard, OR 97223 3UN Plan Review
0 Phone: 503.639.4171 Fax: 503.598.1960 DateB ,ORE l Other Permit:
I . l (..3 It n Inspection Line: 503.639 p TTIG Date Ready 1" ® See Page 2 for
Internet: www.tigard- or.gov L IN G D IVISION ethod: ? m0 Supplemental Information
BUJ /I, /.�i rWA ,
TYPE OF WORK QUIItED D • - AND 2 -F .t 11 Y DWELLING
El New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ `( l ( 1 , ��
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
SOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: iss 90 70 . yo .-H-Ht New dwelling area: square feet /
City/State/ZIP:-,, ` , 0,..P__ Garage /carport area: square feet
Suite/bldg. /apt. no.:i Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: 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.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK • work indicated on this application.
•
Id 62‘ OJ Valuation: $
IC 1 Existing building area: square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: t t_..„).(- t� k cr l.. Rao t: E2 Type of construction:
Address: Q 0-10 t J ) - 6--0 i.., Occupancy groups:
City /State /ZIP:� 4 Q. > v2 Q7 Ag-77 Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT • • ❑ CONTACT ,PERSON
NOTICE
Business name:.- CiAp c.¢., (;)454 ■•VC—t All contractors and subcontractors are required to be
Contact name: El 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: ( ) I Fax:: ( )
E -mail:
CONTRACTOR - .
Business name: ✓°'3 atilt f S{ - `, L BUILDING PERMIT FEES*
Address: t 4-3 g Sw i2 -e i ( tki. (Please refer to fee sekeduk)
City /State /ZIP: f-k (( Sb0 r/b ) (�(� / Z3 Structural plan review fee (or deposit)_
Phone: (50 3 9, Q - 5 ( f Fax: ( )
FLS plan review fee (if applicable):
CCB lic.: ) 73 o ' 0 / t t 10
Total fees due upon application:
c �
Amount received: 1410. GZ
Authorized signature: This permit application expires if a permit is not obtained
�_���, within 180 days after it has been accepted as complete.
Print name: (eej &Y AA_. Date: (el q 1 '2.00 • Fee methodology set by Tri-County Building Industry
J IJ Service Board.
1: \Building\Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB)
Building Permit Application Checklist -
One- and Two - Family Dwelling FOR ( 1iti1.: ONI.V
City of Tigard Received
74 Date/By: Permit No.:
O 1 3125 SW Hall Blvd., Tigard, OR 97223 Associ ted ermits:
C Phone: 503.639.4171 Fax: 503.598.1960 P
T1 �_ It D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
"1'1-11: FOLLOWING ITEI\'IS ARE REQUIRED FOR PLAN REVIEW 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 1IONAI_. ' PI (11 ICS
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.doc 03/21/06 440- 4613T(1l /02/COM/WEB)
..Mechanical Permit Application � FOR OFFICE USE ONLY Cl g of Tigard eceived
Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 p 9 2 009 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � U N Date/By: Other Permit:
® Inspection Line: 503.639.4175 Date Ready/By: Juris: (21 See Page 2 for
Internet: www.tigard-or.gov
CITY OF TIGp ` I) Notified/Method: Supplemental Information
BUILDING ntVISI •
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction G. 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*
a1- 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: /c70 5a/ 7 - _
Air conditioning
fires ite plan ho or in placement)
re wires site Ian showin 14.00
City/State /ZIP: r7 q 0 ,- ( 4 U r Fumace 100,000 BTU ( ducts/vents) 14.00
/ Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: - Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00 (0
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
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00 .
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: _ 10.00
Business name:
1.1. d5 a . P C - c Fuel piping
Contact name: y y $5.40 for first four; $1.00 for each additional
Address: J Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater ,
Phone: ( ) Fax:: ( ) Water heater
Fireplace -
E -mail: Range
CONTRACTOR Barbecue
Business name: �/kGt c.1. ( #.J .k Cod (t �� Clothes dryer (gas)
/ Other:
Address: ? 5 jam+ C 2 - , tit /20 MECHANICAL PERMIT FEES*
City /State /ZIP: (o ft-/L-r. 0g 9 1 7 4 9.- - 3 Subtotal
Fax: ( ) Minimum permit fee ($72.50) -72 . 50 Phone: ( ) (8�0_ � ' 3 Plan review (25% of permit fee)
CCB lic.: (4 67 g State surcharge (12% of permit fee) €3 3 0
TOTAL PERMIT FEE Ai , Z0
This permit application expires if a permit is not obtain within 180
Authorized signature: days after it has been accepted as complete.
Print name: I Date: • 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 Valuation: Permit Fee:
$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 \NEC- PermitApp.doc 01/19/07 2
Plumbing Permit Application
Building Fixtures RECEIVED 14012 OFFICE: Hsi.: ONLY
- City of Tigard Received
g 0 9 2009 Permit No.:
IIII a 13125 SW Hall Blvd., Tigard, OR 97223 JUN Date/By:
Review
C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175
DateB
.. OFTIG
f I G n R D Internet: www.ti ard - or. ov BUILDING DIVISI Date Ready/By: Juris S See Page l Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
XI Addition/alteration /replacement ❑ Other: • New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . SFR (1) bath 249.20
111'1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 9o7O � bt-) 70 h 4 V v Catch basin or area drain 16.60
71 ,,,,,_,
City/State /ZIP: 1nr. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector _' 16.60 1 LI> (
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
• • DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER • ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: pi ch oice. , /�� ,,, Vv\
l ) Interceptor /grease trap 16.60
Contact name: r!4,'V5 4" A Medical gas (value: $ ) Page 2
'^ g
Address: 3 !{ 3 �{ q Primer 16.60
City /State /ZIP: µ /(bo''o )0e 1 771 Roof drain (commercial) 16.60
; rf56 Sink /basin/lavatory 16.60
( 1 ) G' - Phone: 0 -I Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: • L� /` p (-kt-Sic/at oco, Water heater 16.60
Address: 3 N (,k.) 1,0 t LA t )O b Other:
City /State /ZIP: 0 - 9 it Subtotal
Minimum permit fee: $72.50
Phone: (S (7 ) 57 5"5'r+ Fax: ( ) Residential backflow minimum permit fee: $36.25 �.�
CCB Lic.: ,1 534_q l � Plumbing Lic. no.: c5l/ 11,6: Plan review (25% of permit fee)
All 3 f �� 7 , / fir State surcharge (12% of permit fee) ,70
Authorized signature: 11 l TOTAL PERMIT FEE 76
Print name: ( �� ..( Date: ki91 200 1 This permit application expires if a permit is not obtained within
J ` _ J { y 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
. Fixture or Item • Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan. Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
• Fixture Type: • Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918 -780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator _ Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
•
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06
Electrical Permit Application C R eceived
FOR.Orrlci.: USE ONLY
0 City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd., Tigard,OR 97223 SUN p V LAW" Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
® Inspection Line: 503.639.4175 F TIG . , ' Date Ready/By: 3uris: ® See Page 2 for
Internet: www.tigard - or.gov C%T' 0 .1IgII Ih{otified/Method: Supplemental Information
P
�7. "TYPE OF WORV --- DIPIG I PLAN REVIEW
❑ New construction ddition/alteration /replacement Please check all that apply (submit 7 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
10- 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: 946 f 7p �p � 100HP or more. occupancy.
/V " � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: o v ❑ 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 Qtv 1 Pee. 1 Total 1
New residential single- or multi- family dwelling unit.
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.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85
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, Qer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 CONTACT PERSON above service or feeder fee, 6.65 2
vqF e Cpbs Lt C� � Fee branch circuit
Business name: t B. Fee for branch ch circuits
Contact name: without service or feeder fee, 46.85 "ice 8. . 2
'�( first branch circuit _
Address: J Each add'I branch circuit 6.65 ( , tp/j 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
�. .e ✓ 5v>7 j. ` (y t L /4„_C___ Signal circuit(s) or limited -
Business name: t panel, alteration, or
Address:
g3 t T L /� E � n extension. Describe: Page 2 2
City/State /ZIP: i4- L_. - J 62 7. G
7/a 4 Each additional inspection over allowable in any of the above
G Per inspection 62.50
Phone: (503) t (��� D g F ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: / ypt ( Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
/c ELECTRICAL PERMIT FEES
Suprv. Ele trici sig nature, required: Subtotal: - ‘ . 2 Gl 1 0
t
Print name: Date: Plan review (25% of permit fee):
State surcharge (12 %ofpermit fee): (, 4 `l
Authorized signature: TOTAL PERMIT FEE: 51, Q f �
This permit application expires if a permit is not obtained within 180
Print name: Date: 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(1I/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*
p 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*
❑ 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