Permit y u
1111 CITY OF TIGARD MASTER PERMIT
Permit MST2011 -00054
` COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/28/2011
Parcel: 2S1 12 BD00800
Jurisdiction: Tigard
Site address: 7700 SW BONITA RD
Subdivision: DURHAM ACRES Lot: 66
Project: Hulquist
Project Description: Replace header in doorway, electrical work and install new gas fireplace.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 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: 0 sf Value: $500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 15
Ea addl 500 sf: 0 201 -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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
HULQUIST, MARY ANN OWNER Required Items and Reports (Conditions)
10765 SW FAIRHAVEN ST
TIGARD, OR 97223
PHONE: 503- 639 -5168 PHONE:
FAX:
Total Fees: $435.03
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 ru -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA 952- 001 -0090. You may obtain a c• • • . - 1 - • ect questions to OUNC by calli 503.232.1987 or 1.800.332.2344.
Issued �� __� Permittee Signature: (f'�/ 44
Call by 7:00 a.m. for the next available inspection date. ` vV '
This permit card sha • e ' - • a conspicuous place on the job site until completion th e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application EC E I + 67- € EX f i- D /7- * X
Residential 4� IVED
esldent FOR OFFICE USE ONLY
APR 1 2 2011 m (2C - - I I 1
City of Tigard Date /B Received : Permit No.://
•
111 13125 SW Hall Blvd., Tigard, OR 97 , O F TIGA. iD Plan Review'„, � ��
j
_ Phone: 503.718.2439 Fax: 503.59j Date /B : / Other Permit:
TI G A K U Inspection Line: 503.639.4175 hoUILDING DIVISION Date Ready /By: , � '/� funs: El See Page 2 for
Internet: www.tigard- or.gov Noti0;M 7 a Supplemental Information
TYPE OF WORK / r REQUIR i DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X Addition/terationlreplacement ❑ Other: equipment, materials, labor, overhead, and the profit for the .
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
1A: and 2 family dwelling ID Commercial /industrial 57)10
❑ Accessory building ❑ Multi - family Number of bedrooms: Z
El Master builder ❑ Other: Number of bathrooms: 2-
JOB SITE INFORMATION AND LOCATION Total number of floors: `Z
Job site address: 77L> , , J �� ^ -A , 20 New dwelling area: /()/i square feet
City/State /ZIP: --'i-t Q a . Gt"IZZ(--1 Garage /carport area: NI 1 /k square feet
Suite/bldg. /apt. no.: Project name: 14u/ t /I J -51- - Covered porch area: �k square feet
Cross street/directions to job site: � Deck area: /JfA square feet
Other structure area: NI4- square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
�, ,, , � , s c if .` ,,a , r; . work indicated on this application.
Valuation: $
RiEpc..p,ro i .T. t t^ Z> fL u
Existing building area: square feet
New building area: square feet
PROPERTY' OWNER ❑ TENANT Number of stories:
Name: //! LJ IA/A/ /7t j -42v/ s7 Type of construction:
Address: /2 r`, /� ,), ,ii , ,V 4 l/2 ,f/ ■� Occupancy groups:
City /State /ZIP: Ott_ 1 LZ 3 Existing:
Phone: ( 03) 6 3 _ 4: 5-- /, 6 e r Fax: ( ) New:
❑ APPLICANT kCONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: itylka, f t .tt) o
FLS plan review fee (if applicable):
Address:
Total fees due upon application:
City/State/ZIP: C.03 r ax: � --1 Amount received: 4 t31/. 42 3 Phone: (J67 �?,. R -� �� : ( ) t
E - mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercia .nd residential prescriptive installation of
CONTRACTOR,
, _, Viz_ -gy '; � J _, ,, roof -top mou -d Photovoltaic Solar Panel System.
Business name: T , f, „� - Submit two (2) s • of roof plan with connection details
` "lNv ` and fire department . ess, along with the 2010 0 egon
Address: Solar Installation Speci, Code checklist
Permit Fee includes
City/ State/ZIP: ( p ' . e $180.00
and admini e
Phone: ( ) Fax: ( )
States ge (12% of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not i stain c--- 71,1 , a..4 6,7te..c...., �� within 180 days after it has been accepted as corn. lete.
Print name: � / !S T _/� �� * F ee methodology set by Tri- County Building Industry
/�(/ Service Board.
L:\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM /WEB)
' Electrical Permit AppliR EIVED Folz OFFICE 1 SF ONE)
111
Received ��
City of Tigard �p�
Date/B : Permit No.: �! �r� '
• 13125 SW Hall Blvd., Tigard, /(32 2 I Plan Review egm
Phone: 503.7182439 Fax: 503.598.1960 DateBy: Other Permit:
TI G A R D Inspection Line: 503.639.417� 1/ OF TIG, D Date Ready/By: Jas: ® See Page 2 for
Internet: www.tigard- or.got I�LnING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK 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
Niir 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: 770(1;, SV Expo %.t-A 2_0 1 or more. occupancy.
❑
❑Six Six or or more residential units. Recreational vehicle parks.
City/State /ZIP: - Tv a 1 t..- 4 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
hOCI n Cill•CLJ1t5 1t ,. ` ( ,, r ,
'L1GY residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less E 100.70 1 ' k e "t7 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 " 2
�^ 0/ 401 amps to 600 amps 200.34 2
/I
Name: / A��/ , - LL /ST 601 amps to 1,000 amps 301.04 2
Address: -= Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 7 4-/zd , D2 .972-2-3 relocation
Phone: ( ) / Fax: ( ) 200 amps or less 59.36 1
3 ��� 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, acco ding to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Lrb, c. Date: V /Q-- // A. Fee for branch circuits with
❑ APPLIC I ❑ CONTACT PERSON above service or feeder fee, 16 7.42 t) 1 2
each branch circuit t
Business name: B. Fee for branch circuits without
service or feeder fee, first ' X 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name: O Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: 2i 2-.m
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): Z'5. 4 4
TOTAL PERMIT FEE: 61
Authorized signature:
This permit application expires if s permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um be r of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.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:
n Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El 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
n Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El 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
Mechanical Permit Applic r��ii Received Foil OFFICE LSE 1151.1
i
City of Tigard Date/By: IfM Permit No.: / • /_ o,r,..s
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 AT N 1 2 2011 Date/By: Other Permit:
f I t i A R D Inspection Line: 503.639 Date Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
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
I=1 Demolition s ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
fa- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
/ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: - 7700 j/■ eljn \ .A tp (requires site plan showing placement) 46.75
City /State /ZIP: t _ O n, , q1 Furnace 100,000 BTU (ducts/vents) 54.9
�" Furnace 100,000+ BTU (ducts/venis) 54.91 1
Suite/bldg. /apt. no.: Project name: U= r--- Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace / 33.39 3 , 41
I f�Jt.P -∎-co e.Pi5 c purte.i6 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
,JROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: rn h Aj! � ici Environmental exhaust and ventilation:
Address: , �% 1 L,G 6w FA1Nr n 5k. Range hood/other kitchen
equipment 33.39
City/State /ZIP: -11y1/410 ON 6 1 7 7 : 2 : 2 7 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (6)3 ) (:;. — £6( Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
C Barbecue
/
Business name: O o )10 t Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal 3.. , 31
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 5(.... C, I
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) IC , et
TOTAL PERMIT FEE i 07,1
Authorized signature: ` 14(___4(f G � � This permit application expires if a permit is not obtained within 180
W "`r days after it has been accepted as complete.
Print name: Ai /J J )) . Date: j y _ / / ' Fee methodology set by Tri- County Building Industry Service Board
1:'.Building \Permits\ MEC -P App.doc 09 /09/10 440- 4617T(I1 /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.
1:\ Building \Permits \MEC- PermitApp.doc 09/09/10 2
i
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
x / 49/ Z1 /
Print Name of PeO t Applicant
9 ��jC-y�
Signature of Permit Applicant / Date
Permit #: 11T o94!l - acc. 5 t
Address: 77CC ?LA) (b�/T rt
kI2b 9 7 Aa
Issued by: / - Date: 1 / // •
This Copy for Permit Offices