Permit 1 i,..i 1
il CITY OF TIGARD MASTER PERMIT
, ;- � COMMUNITY DEVELOPMENT
Permit #: MST2009 -00137
. ; Date Issued: 07/13/2009
T1GA..RLT 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 Parcel: 2S1046C01700
Jurisdiction: Tigard
Site address: 14160 SW FERN ST
Subdivision: Lot: 0
Project: Hohnbaum
Project Description: Kitchen remodel.
BUILDING
Floor Areas Required Setbacks Required
Stories. 2 Bedrooms 0 First 0 sf Basement 0 sf Left 0 Parking Spaces 0
Height 0 Bathrooms • 0 Second 0 sf Garage 0 sf Front 0 Smoke
Dwelling Units 0 Third 0 sf Right 0 Detectors Yes
Total sf Value $65,000 00 Rear 0
PLUMBING
Sinks 1 Water Closets. 0 Washing Mach 0 Laundry Trays 0 Rain Drain 0 Catch Basins 0
Lavatories 0 Dishwashers 1 Floor Drains 0 Sewer Lines 0 SF Rain Other Fixtures 0
Tubs /Showers 0 Garbage Disp 1 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 1 Other Units 1
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'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)
HOHNBAUM, MICHAEL LEE & KARI OLSEN HOMES & RENOVATION
ROC 1339 MADISON ST NE
14160 SW FERN ST Salem, OR 97301
TIGARD, OR 97223
PHONE PHONE 503 - 393 -5067
FAX
Total Fees: $1,302 99
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 j ENNtO , . egon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are -et forth in OAR
952- 001 -0010 through OA' 952 -S -0100 /f ou may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 .r 1 80 332 2344
Issue By: 1 / , / �. LL `` ►�l Permittee Signature: �
i
' -Buik ing Permit Application
Residential, , "., FOR,O ONLY , .
ECF t�s� Received '
City of Tigard Date/B ) Permit No / t• C.
M
q 13125 SW Hall Blvd., Tigard, OR 97223 JUN 9 20 09 Plan Review �7,, Other Permit
Phone: 503 639.4171 Fax: 503 598.1960 Date/B /,��V
TIGARD
Inspection Line 503 639 ^ y' pp Date Rea. maw Jun H See Page 2 for
Internet' www tigard or.gov CITY Or i luAriD Notified/Method �' ] i Supplemental Information
BUILDING DIVISION ib a f� '-r.
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- ^ I' `t -.. p ; . � ; :T�E�,O F W W OR K , ° ^ 1 ,g ¢ i °. ¢ t +� REQiJIRED g DATA 1 ND'2=FAMILY„DWEI LING „f *'
,..
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❑ 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
=-: � `*” mow' " = tabs.f ,°` re&I" -`= ° 5 ; ."' •,° t - „ work indicated on thi s application.
m�'":. � '� � � � �,' ;�' �, �,.;�,� , =';.•�:��<
.1, -> ' • tCA•TEGORY�O,F`..CONSTRUCTI1ON" "
_: - +..� s ; <i"Z s " .�z.;.s;p'•` a °, S n: "- " cw#- . `;:.k.k;, ;A
< °�.� _: se^, �.-- `t�;�>.�sa�A.*��. t-� ...� -z`u: �,a;�*z,m��sh, a�a=..�.e, _ sdaa �'. �Z,i�W. k'°' �
Of - and 2- family dwelling ❑ Commercial /industrial Valuation: $ 4:5 0 O
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
:°- ,'aww. ' x - 'x,K .».T:�'aw2xs,.ay - ,;',gi,r t „�..- -«;•�, ,..- w, z.
9 " - : •„, , rJ6B SITE "I NFORMATION A&i6' OCATIO_ -fAlf 4 4 -?"'" ' Total number of floors:
- 4 '•a54'^? � xv ^Sr-. -; •-n: -. .«„ . :R -uK*,s -ds;< N ,°z.>:,i >-& -,,,, .,, - , p:.. a`1,4 ;R .;, "'�,�=;
Job site address: / 1116 5 ) Pertly $771- New dwelling area: square feet
City /State /ZIP: 714A11- o (L 9722,3 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: 14 o/fA/B,9 1 Covered porch area: square feet
Cross street/directions to job site: peleAl 57 0 PP 13S' Deck area: square feet
Other structure area: square feet
RE :1,,,,',;1/2,,,,,,,A.,,••-6,,,,,,,,,,,,,-.,,,,,,,, U `
D `” ` .w :• - rrca• x,. mod.:.. 7.re�r =u4:ax-�r ,141,,, =,a -
A :
Subdivision: 1 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
„, e<<y „� , _ gyp& _ :4 equipment, materials, labor, overhead, and the profit for the
M 4 r " ° , -, ' ° : DESCRI - - -- °'' F x `°fir` ,,° w ork indicated
� 1. _ OF WORK �f; - 4.;. c on this application.
Msx x�: ��tF �%: c; � ,rnw•a.= „�:..�,�.�,x.a °:; �.: ;rs.�»�°I^°:..:�,�::�"^«:: _._ ;� � �:'�v�.a :-
h / `� G � ef f___-t---).0 0 p Valuation: S
Existing building area: square feet
New building area: square feet
PROPERT] pO 14 , 3„„ -4'`- ° '` 4 Number of stories:
..
e.TENANT
,k ��: n�mwx' .�. �:,.r ,.,�:�• Or..:, �= rac.. �r:;. „.�`iz.�,'�'rvr�t�= `= x��� -� .
Name: jell i 'L 1 1-4-4:2. KA-f I 4 13 A{-(,( Type of construction:
Address: /Y 0 5 LJ F 97t/I) 5 j t Occupancy groups:
City /State /ZIP: 6/ye, j t 0 R_ ? 7Z �3 Existing:
Phone: (03) 579 - /6, L 7 Fax: ( )
' * •a=szc T34, •-_t; ; - a, ,,'0 New:
; r” at, ^•'Y' b ' = " s .;�"�• r:y��PP i' nA•,- �,; �i�t *' �,�� " := ?"n`e'ars- ,:�^ - -- .a,,,�,,,. °xta 7w �� - - -
G,ONTAGT PERSON:,, 4 -��: y u<
A LIC : N .41- ^- s s ' .e , , t ° `g ' „„- mss . _ 4;izN r :,; .
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.� t ra � .., •;�+��. =�3�� ,ter g .,°�. �- _.,sW, �'� „� x�.� .,f� �. -'^ :9''
Business name: -O,fI 4 R- 87Io ✓.j/ 0, J All contractors and subcontractors are required to be
Contact name: /10 IGIL 01_5 j , licensed with the Oregon Construction Contractors Board
_ under ORS 701 and may be required to be licensed in the
Address: /'33 / q i i / - ,$ ON 5 �. _ A/1.-' jurisdiction in which work is being performed. If the
City /State /ZIP 5,4-4874 t Q 12 973 �' applicant is exempt from licensing, the following reasons
apply:
Phone: (303) 323 - SO6 7 Fax:: ( 0 4 6, —
E -mail: ,l/ I c K @, OGS2'7UQJ0 ✓ A-ri a ea 4'I
, Rte ., j ra- ,, r s, -� , ;. :�-_ ., ��:-- ,7, TM :. a; iC - i
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Business name: j f9A'1 , i 9 -PPLI C - '-�s- . .
xBUILDilNG'PERMIIFEE$ -:•
Address: „ ;-g `= N- Please re er 10 fee sched r!e) 1 ; ''"» `
City /State /ZIP: Structural plan review fee (or deposit): • C. 4 \ a
Phone: ( ) Fax:
( ) FLS plan review fee (if applicable):
CCB lie.: / (t/ 0 g/ `•5, 0 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
Print name: liq I uL' /9"/�4 EL�- Date: 6// ill Qct within 180 days after it has been accepted as complete.
r * Fee methodology set by Trt -County Building Industry
Service Board
I \Building\Permits\BUP -RES PermttApp.doc 11/6/07 440 4613T(11/02/COM/WEB)
r Electrical Permit Application a 7 r p , . ,. -
-
r �! .F. —+.,' Received FO R. �OFFIC E USE,ONLY
City of Tigard Date /By Permit No .
13125 SW Hall Blvd., Tigard, OR 97223 JUN 19 2009 Plan Review
_ I Phone: 503 639.4171 Fax: 503.598 1960 Date /B Other Permit
Inspection Line' 503.639.4175 q Date Ready /By Juris ® See Page 2 for
,' . L G, Internet: www.tigard -or gov CITY OF T!GARD Notified/Method Supplemental information
TYPE OF WORK'1- .1,ll:''4- 1 ° , t nl7- ' 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
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
Multi - family El Master builder 0 Other: ❑ Fire pump buildings
of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: (-9 110 Fe w\ 100HP or more occupancy
❑
9 y y ❑ 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: M s 1 . l ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I otr I Fee. I Total
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
DESCRIPTION OF WORK (with above sq ft) 75.00 2
tt �t L imited energy, multi - family 75 00 2
£L t- (?, 9i t residential (with above sq ft )
tJ� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ 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 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
g 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: without service or feeder fee,
first branch circuit 46 85 /k(
Address: Each add] branch circuit Q. 6 65 fa iCi 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: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: p �. l.( 1/Y, �� A( ; C Signlp s) or
r limited-
` `� j( j � energy panel, alteration,
Address: U � � a V E. -1 C) extension Describe: Page 2 2
City/State /ZIP: Q O,` Q (W Q (5 `7.6 Each additional inspection over allowable in any of the above
`J �J Per inspection 62 50
Phone: (5Q3)5(3 , 517 Fax: ( ) Investigation per hour (1 hr min) 62 50
CCB Lie.: `� 2 0-17 Electrical Lic.: � a`� Q Suprv. Lie. ���
: �S Industrial plant per hour 73.75
CI , lit , iU '7' I - I t 10. 1 s 1J o ELECTRICAL PERMIT FEES
Suprv. Electrician sig r ,required: Subtotal• ` ,',1J ,
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee). - 7, - 7,
Authorized signature: TOTAL PERMIT FEE J .7' 7
p ')
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\Permus\ELC- PermitApp doe 05/23/06 440- 461ST(11f0S /COMIWEB
Plumbing Permit Application , .
i — Building Fixtures Fna OFFICE 'USE: .ONI Y
' City of Tigard �1 IN '1 9 2.007 Received 5 .a
illi a 13125 SW Hall Blvd , Tigard, OR 97223 V Date /By Permit No
•
Phone 503 639 4171 Fax 503 598 1960 n "°° O Plan Review
�+ , m �� Date/By Other Permit No
Inspection Line 503 639.4175 C �`� rt^ y^ . 1P " y
CI GA Internet www t - goy (� a "it � t ��E� S% t Date Notifieed/Med /Me thod By funs- S See Page 2 for
�l_ . Supplemental Information
;: d;rt�.'; � ".�A., ^��y ..,u„�. _ ::.+�;.. 'w4�,r ��. °,� ,, .,..x -
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:.'�•a�„� ",,.;.Er -. � � _ x - , . ,. - �'n " "• ,r3, 's =.`' -� �. - o;a �.�:.�t: •t�:KS � =�tr..3"^:, � �`�_.
❑ New construction ❑ Demolition For special information use checklist
Desert anon Qt ' Ea Total
1 V Addition /alteration/replacement ❑ Other. New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
,n. �,�,_ .'s>'��;:„ ,� O � =nom �- , ..w.�, -_... ;��,_� , =a� :,��,•
` ;_,' , : x > s• ;., , a a CATEG1tY' O XI-5FISTR`UC fT,01 f R .` ., ,-' ` 't r . < , °" M,' SFR (1) bath 249.20
_ 'm,ar� �.�31•. , _ r ,. e_z` -� ' . �w.rC et+:VS:.rza�� +,:a:3� t� .�. -. P� ? -UT `��:'
►e` 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
<�� � . ,
- max.• -. s*r =�,4 .;= s �cM<- �: :wr,s:: �z�x�,��, � ,,� : w �a�...s. � <s�;, } ,;:
Fire sprinkler ( sq ft.) Page 2
-�.,; °:- tt it B :SX =TE s 1VFOR MAT'ION , , .AN D;= +LOCATION ) ; �' ;; ..
n -
_ ,- �,,- ro-,.�s..,. z�C� .Y: °,.= :_�.`�`^:% -: •:��:aT °.,. -�'�s _.,ria�ar�a, - dr `:a','�°1'� „�°.^,_ Site utilities
Job site address• jig t, O 5 / 27tet/ ST: , Catch basin or area drain 16 60
City /State /ZIP. — 77 - p ' D 12_, , 7223 Drywell, leach line, or trench drain 16 60
Suite/bldg /apt. no. I Project name. Footing drain (no linear ft . ) Page 2
job t.°7 ` 3 $ �. Manufactured home utilities 110.00
Cross street/directions to ob site -
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft ) Page 2
Subdivision I Lot no : Water service (no linear ft ) Page 2
Tax map /parcel no..
Fixture or item
° fx ^a. �; :ate o z mss.. .i, ;an _ . Absorption valve 16 60
. r „:l- r,
° „ DESG v,',e .. __,+ ; ;.0 ,
, -r._.' =._ =:. , ,i, �~u „s ..._;,.`: -,..�” .._- -,, =s _4 % ,,; w ,; Backflowpreventer Page
K l - re. h42' i2g '1 0 b 617_ Backwater valve
16 60
Clothes washer , 16 60
Dishwasher / 16 60 ((„ , tc O
•,, „: <.,, f , .,b ,t . • .,:cn,: „., ,>r :^ ° Drinking fountain 16 60
' v ' . l' P RO PER TY , O W -FR i .5,'! .' , ' - {r . , : . ,7' EIVANT : , ` „,, ' °,
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: ( ) F ax: ( ) Garbage disposal / 16 60 /60, GC
°'s,;.•: ` n y:u. -..r"i ; °a ;' .. , - , .. ; ... - ., t . =7, Hose bib 16 60
,°s t ' ° . d. APPI ICAIVT `k , •>:, y .0 CONT.4CT ,
�:.. � r- ��..�,�;��,�, � e.T ��. - ' ��� „' n =_.... .<�-
.. >;;,, Ice maker / 1660 (67,
Business name. Interceptor /grease trap 16 60
Contact name. Medical gas (value $ ) Page 2
Address' Primer 16 60
City /State /ZIP• Roof drain (commercial) 16 60
Phone ( ) Fax : ( ) Sink/basin/lavatory / 16 60 (6,edz
Tub /shower /shower pan 16 60
E-mail
`,; 4 , : + _ . i . ' '° .._ ,. ;rti, I t o r ; ; ",T `, . 16 60
Urinal
' ~'CONTR ` ° r° w , ,
. .- ._ _.: - ��e §:<..: �� �- �- ,x:,,,- .�.. -� ��'..`�;�:; >� -� �.,r�,� �;tl��s„ Water closet 16 60
Business name: ..,0 v'jjt- 9.4-1_4024 p / J l 8 Air Water heater 16 60
Address: Other.
City/State /ZIP:
Subtotal t "��
Minimum permit fee $72 50
Phone. ( ) Fax. ( ) Residential backflow minimum permit fee $36 25 ,
CCB Lie.: Plumbing Lie no : ,)& _413 PE, Plan review (25% of permit fee)
State surcharge (12% of permit fee) e , ?c .
Authorized signature 1, , (1 &
PERMIT FEE C, 7
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i \Buddmg\Permlts\PLMF- PermttApp doe 12/27/06 440- 4616T(10 /02 /COM/WEB)
Mechanical Permit A lication n `�- w,.
pp I - � i � �,,� ,[1,-, , : . FOR OFFICE USE ONLY
Ini City of Tigard r' ` i7�Y If Received
`J Date/By Permit No
13125 SW Hall Blvd., Tigard, OR 97223 ( � 2009 Plan Review
Phone: 503 639.4171 Fax. 503.598 1960 JUN Date/By: OtherPermit
Inspection Line: 503.639 4175
"T' L G . ^�� OF � � �� Date Ready/By.
y. Jun El See Page 2 for
r.' Internet www tigard- or.gov V Notified/Method Supplemental Information
RI Ill DING D MISI0
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi family ❑ Master builder ❑ Other: Description Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
,' 4 u a Air conditioning or heat pump
Job site address:
t T-' Il ` (requires site plan showing placement) 14.00
City /State /ZIP: Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt. no.: Project name: ,.\1/40 \ n Ll VIA_ Gas heat pump 14 00
Cross street/directions to job site: Duct work 1 10 00 1U-
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
Flue /vent for any of above 6 80
Subdivision: Lot no.:
. Other: 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
\^n •V\ � n f Gas fireplace 10 00
/\Q
-V C' Q Q try Ql h \ 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 ❑ TENANT Chimney /liner /flue /vent 10.00
Other 10 00
Name: Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment I 10.00 10 °
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
Business name: Other 10.00
Fuel piping
Contact name: $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:
Range
CONTRACTOR Barbecue
Business name: \ \ y g 0`vIA .*___At d Othehes dryer (gas)
r
Address: 9 I" Ctkh r �C MECHANICAL PERMIT FEES*
City /State /ZIP: &ilo m l�x O 7 202 Subtotal
Phone: �`�
f,�.,, - , 3i4e1 / Fax: ( ) Minimum permit fee ($72 50) '77 ,
Plan review (25% of permit fee)
CCB lie.: i 5a \Q� l 4. 1010 State surcharge (12 %ofpermit fee) 7 l.
l TOTAL PERMIT FEE � , .2...10
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name. Date: * Fee methodology set by Tn- County Building Industry Service Board
I \Buildmg\Permits\MEC- PermitApp doc 01/19/07 440 -4617T (11 /02 /COM/WEB)
tY -OF TIGARD I
BUILDING DIVISION PERMIT #` � j_ S r 1 6g•3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 4 I (D CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: ��//���� �,V Q� (
OWNER: Y V l IL�/1C.t2/1 #: 1 Z Dv1 ba&MQNE � 7�1 � '7
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
I 6A tek-CAviine. vla C
Corrections /Comments/ Instructions:
� ,PASS LJ PARTIAL APPROVAL CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W)1Z Date: C Phone #: (503) 718 - #1*Kr
ip CITY . F TIGARD
1 � 2c:06 � ���-
'
N. COMMUNITY DEVELOPMENT
TIUARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE •
Permit #: MST2009 -00137
Date Issued;
/,flay
Parcel: 14160 Fern St.
Site Address: _ Ti}zard
Subdivision:
Lot:
Jurisdiction: Tigard
Zoning: Hohnbaum
Project Name: Kitchen Remodel
Description:
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to t o of the
you fax m ail the fo t 3 City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, O R Y
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
South Salem Plumbing Lic
Michael & Kari Hohnbaum 2804 19th St. SE
(503) 579 -1627 Salem, OR 97302
.... _.. P
Phone #: Phone #:
Reg #:
CCB# 159619
PLM# 24- 413P13
AN INK SIGNATURE IS REQUIRED ON THIS FORM
•
— Na e (printed) Att .. taciA.1
Sig' _ture ,f A th +'zed Plumber
Electrical Permit Application - City of Tigard ' •• '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n N • urse Calls
❑ Outdoor Landscape Lighting*
n P • rotective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\PermIts\ELC- PermitApp doe 03/23/06
t • r n
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.
I \Building \Permits \MEC- PermitApp doc 01/19/07 2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
- It -U :. w... � tiii5 x ° , iii x., „ ;, : ate. ' ; A ; . q ,
.1-.. , r .., iNeex: ea° � a tat.0. m.: n .x t / b
l tthtle9 `'z `; P , . ' z ' ; Q,�Y . A r ato A, To "' , z1. :'' r —:
. „,.. % . ,Mt .. ' . F wu _:.. . >, .. k. . ;, ...,.. S u-- Foota e:` . , Pe Fee : � . ..� , ° M a,.
Footing drain - Is' 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 :, •i s. a� - µ�:� :• .. _ •••, ,, a , • . • ,
Va=lu'ano n " . a,'.a x ,Kic„ P
m t ric, :::i 3 A > `.. ` �- � :,,: ;
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
`� M
° -'` "' _,`- •_ k£::' - additional $100.00 or fraction thereof, to and
fixture' o`r ,,,, ` N. free= ea l ,,
F Iterm. �
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
each additional $100 00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00
specially requested inspections - per hour 72 50 $50,001 00 and up $742 00 for the first $50,000 00 and $1 20 for
Subtotal: each additional $100 00 or fraction thereof.
a , i •.� . �- : . � ,
Commercial Fixture Work: ,1^;t:1,.:23,„- � atm
` ; 1-.. Ia n R foi Pl uml zg , sta?lla, t�ons ',-,Ii •S`
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 tip commercial building with water service 2" and
`` , " "M „Quarititiliy Eixture);orhPerformed ~k .
❑ New exterior plumbing site utilities for any complex structure greater, except systems designed and stamped by licensed
, t
Fitu'rI
eype `t:. ,r', a engineer.
" n s,..,__,4 * .i ,5 ;r." 5 , - . = n-I ? ` :' `* Re `lac -- i:
>b _; p d y ' ,E�� s Ngg
:r�'� . s -;, -ms a 1?kevion :;C a 4d�ed," P xi tin
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 s. ='- ° at , ; _,... 1 ;
x . w
1 :4•40>n etric .ar Riser ; Pia ramp! „� t M; `
Drinking Fountain :� � - - -� e.� ,.�:. �.,., _.�' , a _ �,�'; � s ~Fi:;,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2” that meet the qualifications above.
-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 TuildingPertnns\PLM- PermitApp doc 12/27/06