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Permit q CITY OF TIGARD MASTER PERMIT 114 _.1. gY- COMMUNITY DEVELOPMENT Permit #: MST2011 -00032 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2011 Parcel: 2S110CB10300 Jurisdiction: TIGARD Site address: 15426 SW ARLINGTON TER Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 91 Project: Arlington Heights No. 3, Lot 91 Project Description: New SF. 4/22/11, adding combo fire sprinkler system to permit. 11/16/11, reprinted permit after fire sprinkler fees were paid. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1228 sf Basement: 642 sf Left: 5 Parking Spaces: 2 Height: 33 Bathrooms: 4 Second: 1596 sf Garage: 550 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right. 5 Detectors Yes Total: 3466 sf Value: $371,796.96 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 1 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains. Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 200 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr. 0 Ea add'l 500 sf: 7 201 -400 amp. 0 201 -400 amp: 0 W/O Svc /Fdr: 0 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 3466 Owner: Contractor: JT ROTH CONSTRUCTION J T ROTH CONSTRUCTION Required Items and Reports (Conditions) 12600 SW 72ND AVE SUITE #200 12600 SW 72ND AVE #200 1 Ersn Cntrl 503 - 681 - 4444 TIGARD, OR 97223 TIGARD, OR 97223 2 Engineered Soils PHONE: 503- 639 -2639 PHONE: 503- 639 -2639 FAX 503 - 624 -0239 Total Fees: $19,681.37 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OA: -2- 001 -0090. You may obtain a • • • - ..-s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1111111, 0z_i Issued By. _ — - __.�� / Permittee Signature: �� Call 503. . • • .4 :00 a.m. for the next available inspection date. This permit card shall be . ept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. . CITY OF TIGARD MASTER PERMIT M _P - COMMUNITY DEVELOPMENT Permit #: MST2011 -00032 Date Issued: 03/18/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110CB10300 Jurisdiction: TIGARD Site address: 15426 SW ARLINGTON TER Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 91 Project: Arlington Heights No. 3, Lot 91 Project Description: New SF. 4/22/11, adding combo fire sprinkler system to permit. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms. 4 First: 1228 sf Basement. 642 sf Left: 5 Parking Spaces 2 Height: 33 Bathrooms. 4 Second. 1596 sf Garage 550 sf Front: 15 Smoke Yes Dwelling Units: 1 Third: 0 sf Right 5 Detectors. Total. 3466 sf Value: $371,796.96 Rear 15 PLUMBING Sinks. 1 Water Closets. 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals 0 Lavatories 6 Dishwashers 1 Floor Drains 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters. 1 Water Lines' 100 Drains: Catch Basins: 0 Bckflw Prevntr. 0 Footing Drain: 200 Ice Maker: 1 Hose Bib. 2 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units. MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 0 Natural Gas Heat Pump' N Hoods' 1 Other Units: 0 Furn <100K: 0 Vents' 0 Woodstoves. 0 Gas Outlets: 4 Furn > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf 7 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 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. Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 3466 Owner: Contractor: JT ROTH CONSTRUCTION J T ROTH CONSTRUCTION Required Items and Reports (Conditions) 12600 SW 72ND AVE SUITE #200 12600 SW 72ND AVE #200 1 Ersn Cntrl 503 -681 -4444 TIGARD, OR 97223 TIGARD, OR 97223 2 Engineered Soils PHONE. 503 - 639 -2639 PHONE 503 - 639 -2639 FAX: 503 - 624 -0239 Total Fees: $19,463.92 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800 332.2344 Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. I p CITY OF TIGARD MASTER PERMIT 11 , COMMUNITY DEVELOPMENT Permit #: MST2011 -00032 T E G RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2011 , Parcel: 2S110CB10300 Jurisdiction: TIGARD Site address: 15426 SW ARLINGTON TER Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 91 Project: Arlington Heights No. 3, Lot 91 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1228 sf Basement: 642 sf Left: 5 Parking Spaces: 2 Height 33 Bathrooms: 4 Second: 1596 sf Garage: 550 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3466 sf Value: $371,796.96 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 1 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 200 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'' 500 sf: 7 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 0 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. Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 3466 Owner: Contractor: JT ROTH CONSTRUCTION J T ROTH CONSTRUCTION Required Items and Reports (Conditions) 12600 SW 72ND AVE SUITE #200 12600 SW 72ND AVE #200 1 Engineered Soils TIGARD, OR 97223 TIGARD, OR 97223 2 Ersn Cntrl 503 681 - 4444 PHONE: 503 - 639 -2639 PHONE: 503 - 639 -2639 FAX: 503- 624 -0239 Total Fees: $19,463.92 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. A • • a -gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 -0010 through OA- '5 .. 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344. Issue.:y: ' /� ' . i Permittee Signature: / — / I ►' `...4 _ Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. l ig „ RECen Commun ty Development Request for Permit Action y TIGARD Skp ci�y 2 8 (u 11 TO: CITY OF TIGARD 8 ( Jl ( D /N� / � GA 0 Building Division Services Coordinator /S / 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor cir City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) A C,/ L_k d-(Pp / e (� Mailing Address: cgS'r;S `auD 14IA %.k LAI €O-N1 (-JAY City/State/Zip: PO /2.1--- L v ,vim 0Q. 4`721. Phone No.: 503" g 1 ( 4 2 ' ( N ( 6 - 7 o' (N ( 6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): El CANCEL PERMIT APPLICATION. ,� 2> p Po? P/ C /c. (44° 111 REFUND PERMIT FEES (attach receipt, if available). ,5/7 ar73 y 6 INVOICE FOR FEES DUE (attach case fee schedule and explain below)_ MST F /fJ� i,(3/ R-/ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). P�y �N 1 ` Permit #: ao ( ( - coo 3', .sAR-iil(e (�-7L. s ys r 7 Site Address or Parcel #: ( 5L1 oZ ( .,.. pi Q(., N r U ,3 1 p_ Project Name: 421 -1 tJ e.o Tor 14 £ 1(1,14 7 N. 3 Subdivision Name: P (o' /3 1 41641 r6 AJp, 3 Lot #: q t EXPLANATION: r t (1,4_ Pet r.) ILL E (2 � V 5 fE H / -b b t b T N1 ao 11 -0003. oti (4l P.P./H. cif5 nJfi.)f/L /}-7,bEj T 0 . fh tl - Cio5t . 1/, • Signature: ■ A_:_ - �_�.� 1- Date: c lat 1 ii Print Name: 1 ___)tigltj ti F�, A7/21-1■,‘", t4-1 / A/tia / e- /tr}-/ t.- Ca / / /id /% Refund Policy /9 / C�rv/ r /n 9y �- £ s 1. The Director or Building Official may authorize the refund of / 7 n '' '_ /,---e a) any fee which was erroneously paid or collected /n v /41 /t��,C i .S r �/ / b) not more than 80% of the land use application fee when an application is draw n o r anc any review effort has been expen - e . c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date • AS (1 B MT Rte to Bldg Admin: Date B _ Refund Processed: Date By Invoice Processed: Date / / / /O /// B �A�� Permit Canceled: Date By Parcel Tag Added: Date / By Receipt # Date Method Amount $ I:\ Building \Forms \RegPemutActton.doc Rev 07/26/07 Plumbing Permit Application _ ''', „i* -hie E Building Fixtures si i � FOR OFFICE USE ONLY R eceived City of Tigard / PermttNo II 11111 13125 SW Hall Blvd., Tigard, OR 97223 APR 2 2 Z 011 Date/By: # r C Phone: 503.718.2439 Fax: 503.598.1960 Plan Rev -- Nti // D Date/By: r e I � Si .aC� -.0 .rX , Inspection Line: 503.639.4175 CITY OF �� `�%� TlGnRD Date Read /B // jo ! i Juris: ® See Page 2 for ��ll Internet: www.tigard- or.gov n IV !S"'"" tified/Method 7 Supplemental Information e� r EN .. G � //en /V/ d '' FEE* SCHEDULE TYPE OF WORK ❑ New construction ❑ Demolition L---Y For special information use checklist Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional � bath/kitchen 25.02 (1T ❑ Master builder ❑ Other: Fire sprinkler 2sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: (' G f 2- 9 i , j 7& r c- Catch basin or area drain 18.76 1 `' �'� t '7c Drywell, leach line, or trench drain 18.76 City /State /ZIP: - 64 - 12D 2D dl--- 7 Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: 1 Project name: Azi IiV.� e v i Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 / Clothes washer 25.02 C_._O M�' O Sp a t N � � - S '/S 7 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ' ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: �� -�� Fixture /sewer cap 25.02 W Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 . CONTRACTOR - Water heater 37.52 Business name: 6FtLJ 0 j Water piping/DWV 56.29 Address: ..5 ( f...�.. (�V7 i � Other: 25.02 City/State /ZIP: c }'{� CA," b `7 T�2 _ Subtotal Phone: ("5 S ) yf (o ff k 7- Fax: ( ) Minimum permit fee: $72.50 CCB Lie.: / 5 / Plumbing Lic. no.: 2 -- j 19-'?.6 Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: .7 TOTAL PERMIT FEE Print name: ,vl 7- - tj Date: -•-22- // 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.\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02 /COM/WEB) • Plumbing Permit Application - City of Tigard Pae 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 50.03 0 to 2,000 $121.90 2,001 to 3,600 $169.69 Footing drain - each additional 100' 37.52 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge- 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by Fixture Type - Plan Review for. 'Plumbing Installations Fixture Type for Replace/ Plan review is required for of the following. Performed: Capped Added Relocate 9 any ow g' Baptistry /Font Please check all that apply. -- Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash - Each Stall engineer. - Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918 780 - 0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" Car Wash Drain Isometric or Riser Diagram Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings Disposal - Domestic -food related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service - Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\Buil ding \Permits \PLMF - PermitApp.doc 02/24/2011 2 CITY OF TIGARD 11111 ° Community Development TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503.718.2439 INVOICE TO: Legacy Plumbing Customer ID: 159281 Attn: Matt N. Invoice No.: INV2011 -00013 8985 SW Hazelvern Way Invoice Date: November 10, 2011 Portland, OR 97223 Date Due: Upon Receipt Case No_ , ?' -,Site Address Subdivision?, Lot'# of Project Name AmouintiDue MST2011 00032 15426 SW Arlington Terr Arlington heights No. 3, Lot 91 $217.45 Fire sprinkler system added to residential building pernlit. Site copy of plans not picked up and fees not paid. Please remit payment and pick up site plans at earliest convenience. Thank you. cc: J T Roth Construction, Inc. Invoice Total: $217.45 12 Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2011 -00032 Customer ID: 159281 Site Address: 15426 SW Arlington Terr Invoice No.: INV2011 -00013 Project: Arlington Heights No. 3, Lot 91 Invoice Date: 11/10/2011 Date Due: Upon Receipt Invoice Total: $217.45 Amount Paid: $ Office Note: Forward copy of receipt to Dianna Howse when invoice is paid. Please mail payment to: City of Tigard, Building Division 13125 SW Hall Blvd. Tigard, OR 97223 Attn: Dianna Howse 1:A Building \ Accounting \ Invoice doc 04/06 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due • Furnaces >= 100K BTU 2300000 -43102 $54.91 $54.91 $54.91 3/18/11 Check 181841 $0.00 Water Heater 2300000 -43102 $23.32 $23.32 $23.32 3/18/11 Check 181841 $0.00 Gas Fireplace 2300000 -43102 $33.39 $33.39 $33.39 3/18/11 Check 181841 $0.00 Range Hood /Other Kitchen 2300000 -43102 $33.39 $33.39 $33.39 3/18/11 Check 181841 $0.00 Clothes Dryer Exhaust 2300000 -43102 $33.39 $33.39 $33.39 3/18/11 Check 181841 $0.00 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $139.92 $139.92 $139.92 3/18/11 Check 181841 $0.00 Utility Rooms) Fuel Piping 2300000 -43102 $14.15 $14.15 $14.15 3/18/11 Check 181841 $0.00 12% State Surcharge - Mechanical 1003100 -24001 $45.51 $45.51 $45.51 3/18/11 Check 181841 $0.00 Fire Sprinkler 230 - 0000 -43101 $169.60 $169.60 $169.60 Info Process /Archiving - Sm Sheet (up to 230 - 0000 -43135 $21.50 $21.50 $21.50 11x17) Info Process /Archiving - Lg Sheet (over 230-0000-43135 $6.00 $6.00 $6.00 11x17) 12% State Surcharge Plumbing 100-0000-24001 $20.35 $20.35 $20.35 - Totals for Fees $20,432.71 $20,432.71 $19,463.92 $968.79 Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount 181590 Credit Card JT Roth Construction 02/23/2011 $750.00 181841 Check 16228 JT Roth Construction 03/18/2011 $18,713.92 Inc Total Payments: $19,463.92 Balance Due: (---- $217.45 CITY OF TIGARD FEE AND PAYMENT HISTORY . €" w + rr1 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIlGARDD MST2011 -00032 - 15426 SW ARLINGTON TER, TIGARD, OR 97224 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due Building Permit - New Construction 2300000 -43104 $2,069.78 $2,069.78 $2,069.78 3/18/11 Check 181841 $0.00 Plan Review 2300000 -43106 $751.34 $751.34 $750.00 2/23/11 Credit Card 181590 $0.00 $1.34 3/18/11 Check 181841 Plan Review 2300000 -43106 $751.34 $751.34 $750.00 2/23/11 Credit Card 181590 $0.00 $1.34 3/18/11 Check 181841 Plan Review 2300000 -43106 $594.02 $594.02 $594.02 3/18/11 Check 181841 $0.00 DC Provision Review, SF - Ping 1003100 -43112 $64.00 $64.00 $64.00 3/18/11 Check 181841 $0.00 DC Provision Review, SF - LRP 1003100 -43117 $9.00 $9.00 $9.00 3/18/11 Check 181841 $0.00 Info Process /Archiving - Lg Sheet (over 2300000 -43135 $26.00 $26.00 $26.00 3/18/11 Check 181841 $0.00 11x17) Info Process /Archiving - Sm Sheet (up to 2300000 -43135 $62.50 $62.50 $62.50 3/18/11 Check 181841 $0.00 11x17) 12% State Surcharge - Building 1003100 -24001 $248.37 $248.37 $248.37 3/18/11 Check 181841 $0.00 Tig -Tual School CET - Residential 2300000 -24102 $3,639.30 $3,639.30 $3,639.30 3/18/11 Check 181841 $0.00 Park - Single Family Unit 4250000 -43300 $4,811.00 $4,811.00 $4,811.00 3/18/11 Check 181841 $0.00 TDT - Transportation Development Tax 4050000 -43320 $5,227.00 $5,227.00 $5,227.00 3/18/11 Check 181841 $0.00 Erosion Control 1003100 -22002 $112.00 $112.00 $112.00 3/18/11 Check 181841 $0.00 Erosion Plan Review CWS 1003100 -22003 $36.40 $36.40 $36.40 3/18/11 Check 181841 $0.00 Erosion Plan Review COT 2300000 -43107 $36.40 $36.40 $36.40 3/18/11 Check 181841 $0.00 Water Quality - Res 5110000 -43123 $225.00 $225.00 $225.00 3/18/11 Check 181841 $0.00 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $405.98 $405.98 $405.98 3/18/11 Check 181841 $0.00 Limited Energy 2200000 -43103 $75.00 $75.00 $75.00 3/18/11 Check 181841 $0.00 12% State Surcharge - Electrical 1003100 -24001 $57.72 $57.72 $57.72 3/18/11 Check 181841 $0.00 SFR - Baths 2300000 -43101 $525.34 $525.34 $525.34 3/18/11 Check 181841 $0.00 12% State Surcharge - Plumbing 1003100 -24001 $63.04 $63.04 $63.04 3/18/11 Check 181841 $0.00 Air Conditioning 2300000 -43102 $46.75 $46.75 $46.75 3/18/11 Check 181841 $0.00 City of Tigard q Building Division • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Inspection Line: 503.639.4175 T I GA R D Internet: www.tigard- or.gov PAYMENT AUTHORIZATION FORM Permit No. (if available): Job Site Address: Project Name: Credit Card Information: n VISA n MasterCard I Discover (Credit Card Account Number) Expiration Date: Cardholder Name (on card): • Contact Phone No.: Address for this card is: Zip code for this card is: Electrical Trust Account Information: For electrical permit applications only. Trust Account (CCB) No.: Contractor Business Name: Contact Phone No.: I hereby give the City of Tigard permission to pay for the above referenced permit with the credit card or electrical trust account number provided above. Authorized Signature: Name Printed: Date: Please FAX this completed and signed form to 503.598.1960. To protect credit card information, do not email this form. This form will be destroyed after your payment has been processed. I: \ Building \ Forms \PaymentAuthonzation.doc 02/08/2011 Buildil i Permit Application Residential RECEIVED FOR OFFICE USE ONLY Received /^� Q ^ . 13125 SW Hall Blvd., Ti City of Tigard DateB i of 3 1/ Permit N o.: � � � // ;J / Tigard, OR 97223 v (/�! g Plan Review ' 0 . Phone: 503.639.4171 Fax: 503.598.1960 DateBy: -' -,AP - 3/ / O / j Other Permit: o wQa+�X t— d0 Inspection Line: 503.639.4175 Date Read B p pert ' ® See Page 2 for I WARD CITY www.tigard- or.gov CITY OFTIGART) Notified / /� 6.7.7___ / / '�� co Supplemental Information c) ipi' 01 6 i- � A... TYPE OF WORK REQUIRED DATA: 1- AND 2-FAMILY DWELLING CI' 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. R• 1- and 2- family dwelling El Commercial/industrial LI Valuation: $ C1 Accessory building CI Multi-family Number of bedrooms: L I CI Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION A D LOCATION Total number of floors: 3 Job site address: / 5 ')� s ," („Q� New dwelling area: 34 b t square feet City /State /ZIP:' l \ l),,,rd OR- (A-I Garage /carport area: .55c.:.) square feet i ,�^ Suite/bldg. /apt. no.: Project name: Y �I 1, 1 1 S Covered porch area: square feet Cross street/directions to job site: 4, `'"a-�lr^�" 16 . Deck area: 6 I square feet A c��.(o,�_ v Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: .�' A- i t \ We t^ 0 Lot no.: ( A I Permit fees* are based on the value of the work performed. Tax map /parcel no.: We :A0\ 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. ,,e ((—„ -° �- e 0d�-R _ \ \ �h o n Valuation: $ �' Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: APPLICANT ❑ CONTACT PERSON NOTICE Business name: 1 1i� ` 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: ( ) I Fax:: ( ) E -mail: CONTRACTOR Business name: :'C g -kt BUILDING PERMIT FEES* Address: tg.- ( q--, - , / e (Please refer to fee schedule) / Structural plan review fee (or deposit): City /State /ZIP:` 1 O� ei a's Phone: (t 3) , ,g4,3 "7 I Fax: (9 3) 4:..-i-- 6?-3 "� FLS plan review fee (if applicable): lic.: -31 Total fees due upon application oci Authorized signature: ' APP Amount received: 7� 1 _ �� This permit application expires if a permit is not obtained L _ — Date: a �.. within 180 days after it has been accepted as complete. Print name: �-e. 71 - h 3/ `( * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 10 /01/09 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY Received 1114 City of Tigard Received ' ° "N° ■ 1 3125 SW Hall Blvd., Tigard, OR 97223 II Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: T l G A R I) 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑ Plumbing ❑ N1e e , ,, i Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l cs 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 . CI ❑ 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 ❑ ❑ ❑ I architect licensed in Ore•on and shall be shown to be ap plicable to the Iro'ect under review. JURISDICTIONAL SPECIFICS 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. I:\ Building \Permits\BUP -RES -Pere itApp.doc 03/21/06 440.4613T(11 /02/COM/WEB) E1'ectritil Permit ApplicatioiRECEIVED FOR OFFICE USE ONLI Tigard of City Ti Received City g t r! . ( �� Permit SW Hall Blvd., Tigard, OR 97223' EB O paw vie Permt No.: �TaOII� � Er g Phone: 503.718.2439 Fax: 503.598. Date/B ; Other Permit: ' , 41 --412, 3 TIGARD Inspection Line: 503.639.4175 I OF TIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW lit 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 IR 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: , 54a(e t,� Iel.I �Co j O 6 TEA. 100HP or more. occupancy. ❑ ❑ Six or more residential units. Recreational vehicle parks. City / State/ZIP: T 6 ,., ( - 1 ) 6j -- 3 ❑ Health-care facilities. ❑ Supply voltage for more than ("` I I ❑ Hazardous locations. ❑ Service or feeder 600 amps or more. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ,(t v� Es„._,,„,,,,) t� \�` , •, ' " FEE SCHEDULE Cross street/directions to job site: ( j 1Qs4� i� 47‘ ,. 47‘ ,..) � Description I Qty. I Fee. 1 Total 1 • T T j.i New residential single- or multi- family dwelling unit. "r( (y- -( Includes attached garage. Subdivision: tl-- -,r�� ( ., 4) 1 O � \ .� Lot no.: CI 1 1,000 sq. ft. or less I 168.54 4 n "', . , ` " ` y 1 Ea. add' 1 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 \ \* , A, o y „ , l ( � �{ �, residential (with above sq. ft.) - ` 7 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City /State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per 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: , 1 c.1.,..20,,‘ G, v'''('-'-. i Xl V ,..-, B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: i branch circuit " °� f \ ; - .) - z.: Each add'l branch circuit 7.42 2 Address: It (:�0 s., � -- VV � - Miscellaneous (service or feeder not included) c � Each manufactured or modular 67.84 2 City /State/ZIP: \ i , 0 _ 4 _ r x (3& (1"' - "� dwelling, service and/or feeder Phone: (V)'3 ) 5 - - a - S 1 F a x : Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: f,.1/4 rr , sk- r . , t t., - Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: , panel, alteration, or extension. Page 2 2 P (-° . ' — Each additional inspection over allowable in any of the above 4) Address: t; , { / - ' l 1 Additional inspection (I hr min) - 66.25/ hr 1..\11 , a Investigation (1 hr min) 66.25/ hr - City/State/ZIP: �� o�4 1 /1/___ /1/___ I - Industrial plant (1 hr min) _ 78.18/ hr Phone: (s) ) (A I( - cl y L Fax: (51.) ) L'-t' - 1 I- a) Inspections for which no fee is 90.00 / hr specifically listed (%A hr min) CCB Lic.: IC% 1 ( q Electrical Lic.: _ I Ii . Suprv. Lic.: )..$l- ELECTRICAL PERMIT FEES . Subtotal: Suprv. Electrician signature, required: ( 11\7 \ Plan review (25% of permit fee): Print name: 1 ---) S (..\ V n e \ I Date: c11,..-3 i / / State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: I This permit application expires if a permit is not obtained within 180 Print name' _ t Date: a l f days after it has been accepted as complete. • Number of inspections allowed per permit. 1.\ Building \Permits\ELC- PerrnitApp.doe 07/01/10 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* H 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 n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n 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 07/01/10 Mechankkal Permit ApplicatiCEIVED FOR OFFICE USE ONLY CI of TigOard Received _ ' b F �� u 3 �t�Ii Date/By: Permit No.:Mf • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • e � 1 4 7. Phone: 503.639.4171 Fax: 503.598.19 Other Permit: t ! 4003 Inspection Line: 503.639.4175 C��TY OF TIGARD DateBy: T I G A R I) Date Ready/By: Juris: H See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST * El New construction ❑ 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* RI- 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 Q ' �^ G n p /fie Air conditioning Job site address: 19./,2„...40 U3 P 1 �1 tiOTb it.) - Tie Z-K�.- . (requires site plan showing placement) 1 46.75 City/State/ZIP: & C " ,. " I ex... l 1- a.7 -'-5 Furnace 100,000 BTU (ducts/vents) 1 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: C\` p � a% Heat pump 61.06 Cross street/directions to job site: C le_v4 yA 6L,.,wv..-e.�( Duct work , 23.32 Hydronic hot water system 23.32 1 PIrJ e \ -- (/‘‘r C., Ce.- Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 `` l 1 - Lot no.: Flue /vent for any of above 23.32 Subdivision: 11,E p1 Tc�Y, l �l �� I Other: 23.32 Tax map /parcel no.: 1 Other fuel appliances DESCRIPTION OF WORK Water heater 1 23.32 {� Gas fireplace 1 33.39 A....) \ (9`R.AnkA e--1 C.,,y,, Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 1 33.39 City/State /ZIP: Clothes dryer exhaust 1 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) i l 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 / Other: 23.32 Business name:; l�oV�..g'KL► -. Fuel piping Contact name: I`� �* S[A IN `�yt $14.15 for first four; $4.03 for each additional Furnace, etc. Address: �- b p� S‘,1,4 �- t " n r,sr` , c,., (�, p.ey� Gas heat pump City /State /ZIP: 1 l a I r5C u i - i- aa - 5 Wall/suspended/unit heater Phone: (3y'3) (.„3 - -1.:. q 3 / I Fax: : ( Sg3) coy -03.-s Water heater Fireplace E -mail: V n - .k ( 6> J\ .- E ..x'w, , , c, o' --`_ Range CONTRACTOR Barbecue \ „ -x Clothes dryer (gas) Business name: .) 1�+ n \ l 'ty�� -1, Other: Address: e ( i `1 MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal � l 6 9• 1 } D Minimum permit fee ($90.00) Phone: (5) ) S S _ c ^I.6 3 I Fax: (�.) C. 9J 1 - 3,i $ I Plan review (25% of permit fee) CCB lie.: r.{ '7- la.7f i) 1 State surcharge (12% of permit fee) 1 TOTAL PERMIT FEE Authorized signature: / i f tit_ This permit application expires if a permit is not obtained within 180 /Lt.t !�( (/t„ /{L days after it has been accepted as complete. Print name: ,C� � \ Date: 013 * Fee methodology set by Tri- County Building Industry Service Board \ 'M I:\ Building PermitsEC- PermitApp.doc 10 /01/09 440-4617T (I11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi - Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 10/01/09 2 Phurnblln2 Permit ApplicationECENED Building Fixtures FOR OFFICE USE ONLY g Rec eived 2 I CJ M'Sr�t'/- 32 City of Tigard Permit No . 13125 SW Hall Blvd., Tigard, OR 972 Pla Re Phone: 503.639.4171 Fax: 503 M N DIVISION Ao / 5 3 .59 1''''l 1 INGDIVISION y' Other Permit No. I I i RD Inspection Line: 503.639.4175 �3 Date Ready/By: )uris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE 12 New construction 0 Demolition For special information use checklist Description I Qty. 1 Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath ( 312.70 14 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 1 437.78 building SFR (3) bath 1 500.32 ❑ Accessory g ❑ Multi - family Each additional bath/kitchen \ 25.02 ❑ Master builder ❑ Other: Fire sprinkler ()VI sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 154i a6 4 J A �^ �� c L t ¢� Catch basin or area drain 18.76 a a� Drywell, leach line, or trench drain 18.76 City /State /ZIP. ' �\c 0 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: [ Project name: 4Y \l -..6v''\ V ct .\ Manufactured home utilities 50.03 Cross street/directions to job site: b_e_i c2 -V � P.r 1 J Manholes 18.76 i t Rain drain connector 1 18.76 Sanitary sewer (no. linear ft.: .) ( Page 2 Storm sewer (no. linear ft.: ) I Page 2 �/� Water service (no. linear ft.: ) 1 Page 2 V Subdivision: '��r \t 6 -k.-e-'t \ 1 s 3 Lot no.: 't \ Fixture or item: '' Tax map /parcel no.: I Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve I 12.51 �/� Clothes washer ( 25.02 , w � 6- A p _ - �� ` c)''\ ^-a h 0 v\ Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 1 25.02 City/State /ZIP: Hose bib `L 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: , CV '&.,.\--\,, C.,, Sk�..c. '1. 1� �� Primer 12.51 Contact name: Y5\ k Roof drain (commercial) 12.51 Address: kA Go Sw 1 �� Ail ,_. s 0 Sink/basin/lavatory 46 25.02 City /State /ZIP: T 1 /1-,>--a-- Solar units (potable water) 62.54 (' Phone: -a ) 1,,-S°7-.. a (,, - 5 st . Fax:: ( ro'5) 4 .-t - 6a.3� Tub /shower /shower pan l4 12.51 E-mail. ,/� / t Urina 25.02 f -sk t 1 v e k- r°}� -, "," ``C Water closet y 25.02 CONTRACTOR Water heater I 37.52 Business name: ViLl" Q� ‘A..` Water piping/DWV 56.29 Address: $5 % S Sv-- 0.�. P x v\ \ Other: 25.02 City/State /ZIP: p, k 1 a R 9 2 Subtotal Minimum permit fee: $72.50 Phone: (5b3) <6 \6 - 1 %$ Fax: (S-b3 ) a 1 - 4 - Lis $-1.- Plan review (25% of permit fee) CCB Lic.: kS 12 Plumbing Lie. no.: a( - �l y ..)74,444 I ` 1 State surch (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: M of Date: I I This permit application expires if a permit is not obtained within 180 days N Q \ SbY1 3 after it has been accepted as complete. 111 *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 n 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to P and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and includin. $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash Each Stall CI Medical gas and vacuum systems for health care facilities. -Drive Stall CI Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator Thru ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3„ that meet the qualifications above. -4' Car Wash Drain Garbage - Domestic Disposal - Commercial Industrial Comments regarding fixture work: Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: I:\ Building \Permits\PLMF - PermitApp.doc 2 c �� 1 Buil If f ding Division Development Code Provision Review TIGARD Residential Projects Building Permit No: H ✓ ( - AQi I -cco 3 4 . CWS Service Provider Letter Received: Yes ❑ No ❑ N /AX Routed Plans: Original Plan Submittal Date: ' 3 / 1st Revision Submittal Date: �� / '. MI Plan Only I 2nd Revision Submittal Date: / ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact ' YIJ ht. rem' w►k n at 503 - 718 - Li SL or kehsdi t, @tigard - or.gov) Land Use Case No. 5 " f 24ot. - wool Name /far 18,4 gal; A45 A10 . .3 L Zoning /e -7 Er Setbacks: Front 15 Rear Is Side S Street Side / Garage 2 4) EKMaximum Building Height 3 S ` Actual Building Height 3 S. - 3 8 4 C� Visual Clearance 13V asements r E3 Sensitive Lands Type: S/ b, t4 5 rcJ4q `►° G.+ Z r% •' at A4,61.4 044j S 4 L 2. 0 0 2.006 ■ 0 000 Z„ Notes: �aw Ele.ta�ke G uar 3 5 �' • ,! s4A- 2 -004,- (3000 - Y i 3 Lite i R A J -r.d s 7 a. A 1 4 0 . On/ y `Jl ".04.4 b w d , A -4.. . r M an, 4.4 1 r'4. n i it/v.) 4 Il -p EI' m /L k V. i .31 fj P t °...i o rokt `, , .5"' — 6 kI LD �' � 1 �.l� - 3 Pi- • p l Original Plan: Approved ❑ Not Approved E Date: 2 1 1 .4111 Revision 1: Approved ❑ Not Approved E Date: 3/ 8 1 f> V Revision 2: Approved Not Approved ❑ Date: i3 /1/ /II Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @ tigard - or.gov) Actual Slope: ZS sr0 + otes: 7111 -U' @ R-4 a.— 6 C aT Original Plan: Approved !■ Not Approved ❑ Date: Revision 1: Approved N IA.. Not Approved ❑ Date: .f' Revision 2: Approved it, Not Approved ❑ Date: .3 I r (Review Continues on Page 2) Page 1 of 2 Citty rborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) t•' i lee Street Trees ❑ Protected Trees 41 7 / 7 ' / Notes: A4 c�,;�H... a /!'? ij a t La t oo 2" (.. I,j � r f _,- ,,,,,,.1„4 rs4,1- , At.- e p/. . t - 4, 7 , --file , (4, ri.,4_„imip.,k....,0 Original Plan: Approved ❑,, Not Approved O. Date: Y/Poil Revision 1: Approved El Not Approved ❑ Date: J /( ?'t I Revision 2: Approved ❑ Not Approved ❑ Date: •) i Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) ❑ Conditions of A. proval Prior to Issuance of Building Permit Notes • ■ i �i �, 3 //0 : L cc d j.[4 /IL- Gu Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes ❑ s No Al . . • . Date Routed to Building: • Page 2 of 2 From:Mark Stewart Home Design 5035794132 03/02/2011 12:35 #693 P.001 /001 N March 1, 2011 'TIGARD,' V�` City of Tigard 1:44: ; RE: NEW RESIDENTIAL Project Information Building Permit: MST2011 -00032 Class of Work: NEW Address: 15426 SW Arlington Ter. Lot Number: 91 t" °'f. Area: 3466 Sq. Ft. Stories: 3 Builders Name: J T Roth Construction Subdivision: Arlington Hts. The plan review was performed under the State of Oregon Residential Specialty Code (ORSC) 2008 edition. Please respond to conditions below. Q Provide engineering details and calculations for deck design. SCE 566e7 s- ( 2) Provide engineering details and calculations for garage floor and support members. JCS GA}w5. SNEp(' S -2- 3) Show details for rebar in standard footings and foundation. 4) Show all load paths to foundation for all shear walls and load resisting elements, sEe A.TrAcji-ei> CA « SHE6TS 5) Show and provide calculations for retaining wall without any soil on top of and in front of toe of footing. Compaction tests will need to be performed if the footing is as per plans. 5EE 4COSED 61.14 o) SNE6 5- Z 6) Show size and material to be used for all posts. 7) If finished floor height is greater than 12 ft. above grade, then it is considered a story. That would make the house four stories. SJ Engineering calcs do not show lower floor in calculations. 9) Need site plan approval. When responding, provide an itemized letter stating in what way each numbered issue has been addressed in the revision. When submitting revised drawings or additional information, please attach a copy of the enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard in tracking and processing the documents. Respectfully, Date w�f / I ,/ ) , Ipto9lesilt i ` + Post -it` Fax Note 7671 ✓I 1 To ti T From, , e r Dan Nelson �C I I V ` �t Senior Plans Examiner " co.IDeo. 4T Worti- • (503) 718 -2436 Phone r Phone " 7e 2 dann @tigard - or.gov t Fax »�c L tC z Fax 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov 1 - n March 10, 2011 TIGARD City of Tigard RE: NEW RESIDENTIAL Project Information Building Permit: MST2011 -00032 Class of Work: NEW Address: 15426 SW Arlington Ter. Lot Number: 91 Area: 3466 Sq. Ft. Stories: 3 Builders Name: J T Roth Construction Subdivision: Arlington Hts. The plan review was performed under the State of Oregon Residential Specialty Code (ORSC) 2008 edition. Please respond to conditions below. 1) If finished floor height is greater than 12 ft. above grade, then it is considered a story. That would make the house four stories. The actual finished grade needs to be shown on plans that indicates total height of building and height of crawl space. 2) Need site plan approval. When responding, provide an itemized letter stating in what way each numbered issue has been addressed in the revision. When submitting revised drawings or additional information, please attach a copy of the enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard in tracking and processing the documents. Respectfully, �° K).__‘,....-e20 Dan Nelson Senior Plans Examiner (503) 718 -2436 dann @tigard - or.gov 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov Oregon Residential Specialty Code R318.2 • MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, IT �4 . (�,u�rM, � y , am the general contractor or the owner - builder at the following address: • Site Address: City: 1 oxirci) • • Permit #: MST off 0x03 - Subdivision/Lot #: and /or Map and Tax Lot #: To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. - Signature: A i ,/ Date: 1/6/8 Ge r,• ral Contractor or Owner -Buil er • 1: \Buil ding\ Form \RES- MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION T-- •P\V o_wner/ agent for (PLEASE PRINT) (PERMIT HOLDER) do herebil certifi that the folloiii4 meets City of Tigard,lnd use 4nd deel.:0124t standards for st'eet tre Wrisistent th the - a*sroped4 lie plan. , PERMIT NO.: PAST ).6. cc SITE ADDRESS: 13 Li U , Nhi ivv, 1;4(f c-e- SUBDIVISION: Pirj) 6 vl 1.-k& LOT #: I / DATE: 4 14.11-7-17:- (OWNER/AGENT) RECEIVED & VERIFIED BY: DATE: (CTTY OF TIGARD) Tree location verified per approved site plan. I:\Building\Forrns \ StreetTreeCertificate 07/01/2010 Oregon Residential Specialty Code N1107.2 HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: Jurisdiction: — �St 1 Site Address: 1S -4 4b sw A 11^-, iq ra — tee Subdivision/Lot #: A, i / �� . i c f and/or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code Ni 107.2) Signature: �� toppr-ti � Date: G/ l( Owner \ eneral Contractor /Authorized Agent c c Print Name: 6--,6 12_ 1 ORSC Section N1107.2. High- efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact' fluorescent lamps comply with this requirement. The building official shall be notified in writing at the'fmal "inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. I: \Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08