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Permit
CITY OF TIGARD MASTER PERMIT il : -°- COMMUNITY DEVELOPMENT Permit #: MST2009 -00157 TiGAR b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2009 Parcel: 2S104BD10000 Jurisdiction: Tigard Site address: 12631 SW 135TH AVE Subdivision: ALEXANDER PARTITION Lot: 2 Project: Alexander Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 5 First: 800 sf Basement: sf Left: 5 Parking Spaces: Height: 24 Bathrooms: 7 Second: 2040 sf Garage: 410 sf Front: 20 Smoke Dwelling Units. 1 Third: 1194 sf Right: 5 Detectors: Yes Total: sf Value: $428,873.29 Rear: 15 PLUMBING Sinks: 1 Water Closets: 7 Washing Mach: 2 Laundry Trays: 1 Rain Drain: 1 Catch Basins: Lavatories: 8 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 2 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 10 Clothes Dryers: 2 Natural Gas Heat Pump: N Hoods: 1 Other Units: Furn <100K: Vents: Woodstoves: 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 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 7 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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: Owner: Contractor: Required Items and Reports (Conditions) ALEXANDER LIVING TRUST VILLA INC 1 MST No Final until Arborist Approval BY MARION /DOMINIQUE 6925 SE 152ND AVE 2 MST Ersn Cntrl 503 - 681 - 4444 ALEXANDER TRS, 12645 SW 135TH Portland, OR 97236 AVE PHONE: PHONE: 971 -570 -8734 FAX: 503- 761 -5193 Total Fees: $20,502.55 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: )! ) ILJY �` k-- 11/W l� Permittee Signature: 0 / r /I/(L / 0 F �l(/y/!/ •7 Ii fA il Permit Application , titc.P. is %s -a coo p •''' . ' Residential RECEIVED . F OR_ OFFICE U SE ONLY - r City of Tigard DateB 7 / �� Permit No.: / S 13125 SW Hall Blvd., Tigard, OR 23 2 1 2009 Plan Review : Tli� ID © � / � J ^ �� a ��� l Phone: 503.639.4171 Fax: 503.598.1960 Date/By: , Other Permit LptCi0 .-- T I CARD Ins Line: 503.639.4175 Date R e ady `/By: 1u ® See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: iU /5 • , ' ' / (j Supplemental infl," n BUILDING DIVISION .1 0 , NNI _ , ,moo - ailli , TYPE OF WORK , . REQUIRED i :St At 1= AND- - 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 ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead and the profit for the • CATEGORY. OF CONSTRUCTION work indicated on this application. it 873, -7 Valuation: , ) 0 and 2- family dwelling ❑ Commercial /industrial _ ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder CI Other: Number of bathrooms: ., , JOB STTE_ INFORMATION S AND LOCATION: Total number of floors: h Job site address: 42.137 A 137 5 L4,7 / 3 , j 4,..e.., New dwelling area: ......1-3-11,-.-square c - feet ,0 �C City /State /ZIP: i i , j� �}, F � -22 3 Garage /carport area: 4q¢ square feet4 C) Suite/bldg. /apt. no.. Project name: Covered porch area: f %1�-- square feet Cross street/directions to job site: Deck area: ! , square feet ( IAl Other structure area: square feet . REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 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 . -- 'q ,i, DESCRIPTION OF WORK= • work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER , .. - .' TENANT , , - " ' Number of stories: Name: Sd YbL{iyt,;` ,,7tL_. t L; /' 60. fLL ,xp1G Type of construction: Address: I,U y /35-4 Occupancy groups: City /State /ZIP: e 7, , ,02 �7�)` 3 Existing: Phone: (j Q3) 3 — 77 Fax: ( ) New: ` : r4 APP LICANT . - - . . ❑CONTACT ;PERSON. NOTICE - Business name: I All contractors and subcontractors are required to be Contact name: A � � (.. 777 � L, 1 licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: - ' CONTRACTOR Business name: WG, /jW( - BUILDING PERMIT FEES *. . Address: c fec J ., & .-- /S� Ave , , . . (Please refer to fee schedule) y Y O 2/ G �� ` 1 2gtr 6 • © p�� 7 j Structural plan review fee (or deposit): ?;Q. City/State/ZIP: > bi l So FLS p lan review fee (if applicable): Phone: ) WO 3 Fax: O �( 7 c -, 9 3 •_ CCB lic.: /69 it ((A: MA I( Total fees due upon application: � p Amount received: /' Authorized signature: �� V (( N �1 r►t.�C7s C� f� T his permit application expires if a permit is not oynned ��� / / } f within 180 days after it has been accepted as complete. Print name: )., ( j // ` / G� Date: 9 0 * Fee methodology set by Tri- County Building Industry CCC Service Board. I:\Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM /WEB) A Building Permit Application Checklist • { , One- and Two- Family Dwelling • FOR' OFFICE USE ONLY .,. , City of Tigard Received Date/By: Permit No.: a 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: _ Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 • ❑ Electrical ❑ Plumbing ❑ Mechanical ,TIGARD Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE RE UIRED FOR •PLAN REVIEW Yes: No N /A Q 4 - f 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system'permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. -� 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ r- over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project 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 d'ccessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. t.\ Building \Permits\BUP- RES- PermiApp doc 03/21/06 440- 4613T(I1/02 /COM/WEB) E lectrical Permit Application - FOR OFFICE USE ONLY -. City of Tigard RECEIVES Date/By: r (y T 9 _ ie,/1 / Date/By: Permit No 7 — 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '.i. Phone: 503.639.4171 Fax: 503.598.1960 J U L 2 1 2009 Date/By: Other Permit 1 CARD Ins Line: 503.639.4175 Date Ready /B torts. ® See Page 2 for • ,m t Internet: www.tigard - or.gov Notified/Method: Supplemental Information CITY OF TIG ARD - TYPE OF V a l fti.DING DIVISION PLAN; REVIEW , ' rgNew 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 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 y /j ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: / 43 / 5 /35' �A� I or more. occupancy. w l ' ❑ Six x o o or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: - 7 - ;, q' 0,1Z 97 ,2 .2 3 ❑ Health -care facilities. ❑ Supply voltage for more than ��"„ oM �/,� ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: /94/494.C.464,4. i4` ❑ Service or feeder 600 amps or more. FEE- SCHEDULE' Cross street/directions to job site: D I Qty. I Fee. I Total I V/-tAnil--- New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less C 145.15 j..l� 4 Tax map /parcel no.: Ea. add'I 500 sq ft. or portion 1 1 33.40 1 • Limited energy, residential 75.00 2 ' • DESCRIPTION OF WORK (w ith above sq. ft.) Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 • . A PROPERTY OWNER • < ` . . ❑ TENANT 201 amps to 400 amps 4fp 106.85 2 " Name: Spiv? e yam r [ t H ' w �/� 401 amps to 600 amps 160.60 2 - i�/T'L1v'^� 601 amps to 1,000 amps 240.60 2 . "" " Address: /G9_6 , 5 t), /35- /7t( , Over 1,000 amps or volts 454.65 2 "-"" City/State /ZIP: / i ' ail Vie 9A2 ? 2 Temporary services or feeders installation, alteration, and /or J relocation Phone: (' 3) # - . 's - (503) Fax: (�) 5 9`1— iilf6 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, Qer panel Owner signature: i 'u �''Z Date: � .ltu / A. Fee for branch circuits with '❑ .APPLICANT ❑ ;,CONTACT PERSON abov service or feeder fee, ' % 6.65 2 each branch circuit .. - . Business name: B. Fee for branch circuits . Contact name: without service or feeder fee, 46.85 2 first branch circuit • Address: Each add'I branch circuit 6.65 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: .\ 0..n r 0. c t C c �1 C L LC_ Signal p a ne l, a) er or t on , or U energy panel, alteration, or Address: 5 3 2 e S ' J c � extension. Describe: Page 2 2 P _ vvJc ___ City /State /ZIP: t r' is vt Qr 9 7 -2-667 Phone: (5� s� -79U//: Each additional inspection over allowable in any of the above QQ _ Per inspection 62.50 3 �j Fax: (�� 77� 3 � Investigation per hour (1 hr min) 62.50 CCB Lic.: 1 , 7 /Lf6, Electrical Lic.: — wgX Suprv. Lic.: e/e3oS Industrial plant per hour 73.75 ' ELECTRICAL. PERMIT FEES Suprv. Electrician signature, required: Subtotal: 76, Plan review (25% of permit fee): Print name: S f I v I U 2 um 6 Date: 7/1%3 Q State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: 4 2_.4 A. 7...- 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. 1.\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 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* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* • Vacuum Systems* n Other: 1„ COIS'IW CIALi *ORK,ONLYc' Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: El Audio and Stereo Systems n Boiler Controls Ti Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC El Instrumentation • Intercom and Paging Systems • Landscape Irrigation Control* Ti Medical • Nurse Calls • Outdoor Landscape Lighting* • Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\ BuildingWermits \ELC- PermitApp.doc 03/23/06 Mechanical, Mechanical, Permit Applicati ECEIVED ' - F OR O USE ONLY R7 Received r 0 City of Tlgard Date /By: Permit No. 0 a 61 ., IS ° 13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 1 2009 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TifGA Inspection Line: 503 Ready/By: ® See Page 2 for ^ , Internet: www.ti ard or.gov CITY OF TIGARD Date )urns g BUILDING DIVISION Notified/Method: Supplemental Information '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: $ 1 -and 2-family dwelling RESIDENTIAL EQUIPMENT /SYSTEMS`FEES* [ y g ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total .--:---- - - =-- -- - , -JOB_ SITE - INFORMATION AND- LOCATION s- -° - --- -' - Heating/cooling Job site address: 043 / t/ /3,5 ilikef, Air conditioning or heat pump i 14 .00 (requires site plan showing placement) 1 4 k City /State /ZIP: / U 6i i/ q7 -,2.2. 3 Furnace 100,000 BTU (ducts /vents) 14.00 Suite/bldg. /apt. no.: Project name: ° �� Gas heat 100000+ BTU (ducts /vents) 17.90 17.� U Gas hea 14.00 Cross street/directions to job site: 1�'v�(.( Zv Duct work 10.00 - Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 • Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances ., ` DESCRIPTION OF WORK Water heater Z...-- 10.00 26 . Gas fireplace 10.00 /(' kLLATI ;hH D C d < ?-u R M A Ca ,A.t -< - (11. o,fL-1,, Flue vent for water heater or gas ( fireplace 10.00 TO CA 79.- fl 3 C . S '` Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 ' - . 0 PROPERTY OWNER - . 0' TENANT Other: 10.00 Name:Apyw /fit✓ `L /%4 .4 �j„ Environmental exhaust and ventilation /� ��L Range hood/other kitchen Address: /.9_6 7 J 51 35" equipment ‘ 10.00 I t City /State /ZIP: �/� 9 �� Clo thes dryer er exhaust 'Z 10.00 20 j � �� �'` Single -duct exhaust (bathrooms, Phone: ( 5 � p 4 l - E3 Fax: ( 503) 5-9Q -y / 4 c toilet compartments, utility rooms) (O 6.80 ❑ APPLICANT ❑„ CONTACT PERSON ' , Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. ( 5- Gas heat pump • . City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater '2- Fireplace E Range _ . ,- CONTRACTOR - Barbecue . IBusiness name: ,...,, w e c Li_ c Clothes dryer (gas) Other Address: 1. f 6 ft SLw of Z k.---4 pc._ MECHANICAL PERMIT`FEES* City /State /ZIP: �� 0 rZ ) ' Z2 , Subtotal 1 'U ) Fax: ( /./ Minimum permit fee ($72.50) Phone: ( v �� o s � � �� � 6 20 Plan review (25% of permit fee) CCB lie.: i5 f f / 31 � 4l State surcharge (12% of permit fee) is. fp4- TOTAL PERMIT FEE 17 ,et ar Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: C-'Pa 'i C „. t 'E 54 Date: (at ' Fee methodology set by Tri- County Building Industry Service Board I \Building \Permits \MEC- PermitApp doc 01/19/07 440 -4617T (1 I /02 /COM /WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total .Val 'Permit $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. 9 I:\ Building \Permits\MEC - PermitApp.doc 01/19/07 2 Plumbing Permit Appliiratio ECE'VED Building Fixtures JUL 2 1 ZOOS `FOR OFFICE USE ONLY . • City of Tigard OF TIGARD D Da e / B y : .7 , A l 9 P e r m i t No.: ) r8 9. e0(55 7 1 a 13125 SW Hall Blvd., Tigard, OR 9 Phone: 503.639.4171 Fax: 503.'' -r: !?* t Plan Review ING DIVISION Date/By: Other Permit No.: T I GAR D Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information • TYPE OF WORK • ' FEE* SCHEDULE' 7 New construction ❑ Demolition For special information use checklist. Description 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 249.20 1-1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 I l Each additional bath/kitchen 4- 45.00 1 O ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 - JOB SITE INFORMATION AND .LOCATION Site utilities Job site address: )26 3 / 5 (Lt/ / 354 44.f , Catch basin or area drain 16.60 City /State /ZIP: �g , v g f7 .2 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no I Project name: ,t; 3.Kcuti RP 6e. Footing drain (no. linear ft.: _ ) Page 2 � /af, Manufactured home utilities 1 10.00 Cross street/directions to job site: - Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: .2 pH Water service (no. linear ft.: _) Page 2 • Fixture or item Tax map /parcel no.: Z 0O/ --04 /3 Absorption valve 16.60 • D ESCRIPTION OF WORK Backflow preventer Page 2 Meow G Q` =yt U ( S'3'(„,- Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 V1, PROPERTY OWNER • . L / ID TENANT , Ejectors /sump 16.60 Name: ryK L /l / / EG i �1 4 i/L / (�Y`Lf. �it'L� � 6�L/[`7'�- Expansion tank 16.60 Address: S tx./ /35 47,14 . Fixture /sewer cap 16.60 City /State /ZIP: ; CJok. 9„2,2•3 Floor drain/floor sink/hub 16.60 Phone: (5 f; -_ .y�3 Fax: ( 6 Q•- 4/46 Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 " Ice maker 16.60 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: Sink/basin/lavatory 16.60 ( ) Fax: ( ) Tub /shower /shower pan 16.60 - E -mail: Urinal 16.60 • CONTRACTOR . Water closet 16.60 . usiness name //J ��� Water heater 16.60 Address: 1 B p d --- ®. /2 j ; , Other: Subtotal $72.50 :511 City /State /ZIP: / �, � � 0 �, , / 11' Water Minimum permit fee: Phone: (S/23 )) ' r / ae,g3 / Fax: (51,3 ) Residential backflow minimum permit fee: $36.25 CCB Lie.: 1818L/b t ,I ut\r Plumbing Lie. no.:P5 56 Plan review (25%ofpemtit fee) d/ l( State surcharge (12% of permit fee) �j�(' ,% Authorized signature: g pit; TOTAL PERMIT FEE Print name: '6. Z �/�!�'If . Date: yle/a7 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. C\Building\Permits\PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard , Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site iJtilities: • Qty: Fee,(ea) ' fotal - Square h'ootage Permit Fee: Footing drain - V' 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 Storm & Rain Drain - 1st 100' 55 00 Valuation: ' " . ` ' r Permit-Fee :. ,' . . _. $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 i xture Or Item. ` Fee (ea)a Total: additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000 00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100 00 or fraction thereof Commercial Fixture Work: " P lan Review : for Plumbing Installations` ' Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed F xtare Typea greater, except systems designed and stamped by licensed = �.. Replace engineer. Previous ' Capped. ..Added Existing' ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. - Drive Thru Cuspidor /Water Aspirator . • Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain - Isometric' or Ri Diagr' am Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i \ Building \Permits\PLM- PermitApp.doc 12/27/06 City of Tigard, Oregon 13125 SW Hall Blvd. ® Tigard, OR 97223 August 25, 2009 RE: RESIDENTIAL IMPROVEMENT T I 1A R 0 Project Information Building Permit: MST2009 -00157 Class of Work: NSFD Address: 12631 SW 135 Ave. Lot Number: NA Area: 4034 Sq. Ft. Stories: 3 Builders Name: Janos Vince Subdivision: NA The plan review was performed under the State of Oregon Residential Specialty Code (ORSC) 2008 edition. Please respond to conditions below. 1) Provide accurate site plan showing all lot corner elevations. 2) Engineered floor joist plan different from what is shown on plans. 3) Beams and calcs are not the same as beams called out on engineered floor joist plan. 4) Provide slab edge insulation and show vapor barrier under slab for future living space. 5) Provide engineered non pinned retaining wall detail for south foundation wall. ) Provide additional mechanical measure required by Table N1101.1(2). 7) Site plan on plans does not match other site plan. 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, kal Dan Nelson Senior Plans Examiner (503) 718 -2436 dann @tigard - or.gov Phone: 503.639.4171 ® Fax: 503.684.7297 e www.tigard or.gov • TTY Relay: 503.684.2772 • City of Tigard, Oregon • - 1.3125 SW Hall Blvd. • Tigard, OR 97223 a Wednesday, December 16, 2009 TIGARD Ms. Dominique Alexander 12645 SW 135th Ave. Tigard, OR 97223 RE Transportation Development Tax (TDT) Refund. Permit No. MST2009 -00157 for 12631 SW 135th Ave., Alexander Partition. Dear Ms. Alexander: At the time the above building permit was issued you paid a Transportation Development Tax (TDT) fee of $4,599.00. Effective December 1, 2009, Washington County approved a Temporary Discount on TDT charges and has made that discount retroactive to July 1, 2009. The enclosed check represents a refund to you of the difference between your original TDT payment for your project and the new Temporary Discount charge. The amount of the credit refund is $920.00. Please call me at 503 - 718 -2426 if you have any questions. 4 bert Shields Permits /Projects Coordinator 503- 718 -2426 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 111 q City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Dominique Alexander DATE: 12/10/09 12645 SW 135 Ave. Tigard, OR 97223 REQUESTED BY: Dianna Howse AMS TRANSACTION INFORMATION: ' ' Receipt #: 175820 Case #: MST20009 =00157 Date: 10/28/09 Address /Parcel: 12631 SW 135th Ave. Pay Method: Check Project Name: Alexander Partition EXPLANATION: Refund amount discounted for TDT per Washington County. RE ?UND:INFORMATION: ';° Revenue. Account, No: :Refund:; Fee -Descnpaon:From ;.� ., _ �`Exaniple W 4040142.: . 245 =0000 _ 4 4 2000 . nt - TDT - Transportation Development Tax 4050000 -43320 $920.00 TOTAL REFUND: $920.00 APPROVALS: \\ If under $5p0;; Professional Staff CJ �� If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board Refund Request Reviewed: Date: !r TM;.'' By: Case Refund Processed: Date: •, By: - OS 1: \Building \Refunds \RefundRequest.doc 04/13/09 • CITY OF TIGARD RECEIPT C . 13125 SW Hall Blvd., Tigard OR 97223 • 503.639.4171 TIGARD Receipt Number: 176353 - 12/18/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2009 - 00157 $ 920.00 Total: $- 920.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 102105 DHOWSE 12/18/2009 $- 920.00 Payor: Dominique Alexander Total Payments: $ - 920.00 Balance Due: $920.00 • Page 1 of 1 CITY OF TIGARD RECEIPT p . 13125 SW Hall Blvd., Tigard OR 97223 • - - '' 503.639 4171 . Receipt Number: 175820 - 10/28/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2009 -00157 Building Permit 2300000 -43104 $2,190.77 MST2009 -00157 12% State Surcharge - Plumbing 1003100 -24001 $69.48 MST2009 -00157 Plan Review 2300000 -43106 $219.55 MST2009 -00157 CDC Plan Review, RES 1003100 -43112 $46.00 MST2009 -00157 CDC Plan Review, RES - LRP 1003100 -43117 $6.00 MST2009 -00157 12% State Surcharge - Building 1003100 -24001 $262.89 MST2009 -00157 Metro Const. Excise Tax - Residential 2300000 -24011 $514.65 Use MST2009 -00157 • Beaverton School CET - Residential 2300000 -24101 $4,034.00 MST2009 -00157 Park - Single Family Unit 4250000 -43300 $5,370.00 °°'': MST2009 -00157 TDT - Transportation Development Tax 4050000 -43320 $4,599.00 <�'-- MST2009 -00157 Erosion Control 1003100 -22002 $136.00 MST2009 -00157 Erosion Plan Review CWS 1003100 -22003 $44.20 MST2009 -00157 Erosion Plan Review COT 2300000 -43102 $44.20 MST2009 -00157 Water Quality - Res 5200000 -43123 $225.00 MST2009 -00157 Water Quantity - Res 5200000 -43122 $275.00 MST2009 -00157 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $378.95 MST2009 -00157 Limited Energy 2200000 -43103 $75.00 MST2009 -00157 12% State Surcharge - Electrical 1003100 -24001 $54.47 MST2009-00157 Air Conditioning or Heat Pump 2300000 -43102 $14.00 MST2009 -00157 Furnaces >= 100K BTU 2300000 -43102 $17.90 MST2009 -00157 Water Heater 2300000 -43102 $20.00 MST2009 -00157 Range Hood /Other Kitchen 2300000 -43102 $10.00 MST2009 -00157 Clothes Dryer Exhaust 2300000 -43102 $20.00 MST2009 -00157 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $68.00 Utility Rooms) MST2009 -00157 Fuel Piping 2300000 -43102 $5.40 MST2009 -00157 12% State Surcharge - Mechanical 1003100 -24001 $18.64 MST2009 -00157 SFR - Baths 2300000 -43101 $579.00 MST2009 -00157 Plan Review 2300000 -43106 $454.45 Total: $19,752.55 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 5524 LSELLERS 10/28/2009 $19,752.55 Payor: Dominique Alexander Total Payments: $19,752.55 Balance Due: $0.00 Page 1 of 1 il ,� CITY OF TIGARD CERTIFICATE OF OCCUPANCY Permit #: MST2009 -00157 COMMUNITY DEVELOPMENT Permit Issued: 10/28/2009 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S104BD10000 Jurisdiction: Tigard Site address: 12631 SW 135TH AVE Subdivision: ALEXANDER PARTITION Lot: 2 Project Description: New SF Class of Work: NEW Type of Use: SF Type of Constr: VB Occupancy Group: R - Occupancy Load: Fire Sprinkler Required: Project Name: Alexander Partition Owner: ALEXANDER LIVING TRUST BY MARION /DOMINIQUE ALEXANDER TRS 12645 SW 135TH AVE TIGARD, OR 97223 Phone: Contractor: VILLA INC 6925 SE 152ND AVE PORTLAND, OR 97236 Phone: 971 - 570 -8734 Fax: 503 - 761 -5193 This Certificate issued 9/28/2011 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the 2008 State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. Mark VanDomelen Building Official City of Tigard POST IN CONSPICUOUS PLACE