Permit t
272 0
Building Permit Applicat'o>
c il =� FOR OFFICE LSE ONLY
City of Tigard � �_ li. Received e 8 rI DateB �1� Permit No.. �J /L.
13125 SW Hall Blvd., Tigard, OR 97223 67U oe A Plan Review �/ �/ -
Phone: 503.639.4171 Fax: 503.598.1960 " "^r l s F � Date/By: Other Permit: ` :a fOa" � a-
Inspection Line: 503.639.4175
ED '� I ' Date Ready/By: 0 See Attached Checklist for O
Internet: www.ci.tigard.or.us rg Notified /Method: Supplemental Information
Permit fees are based on the value of the work performed.
5 10
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a, _ E- O ,ARE IIIItEDsA tTtA °1=t Sl A 2'1?AMILI D1�'ELTsING>
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® New construction CC e
�`IO+N *
e V i I e ii ,-1 �� ' Indicate the value (rou nded to the nearest dollar) of all
❑ Addition /alteration/replacement �' Other: `� 1 equipment, materials, labor, overhead, and the profit for the
tr �,y >�''3;;= x• , = CA � ;°. t •'�;,35,>;;, > >sr >_ -.:. v . 14: wor indicated on this application.
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NI 1- and 2-family dwelling Valuation: $
y g ❑Commercial /industrial i
❑ Accessory building ❑ Multi- family Number of bedrooms: 14
3 ❑ Master builder ❑ Other: Number of bathrooms:
g;,, :c \ :; �, :'. € t ' I�x:, sx.N : ": " >;. fi= ": a =`_: `,,
�:; 'i� ` �y � l�<� ry,�(y��Y�```' �� ";` /�^,. �+ '�', °;' Total number of floors:
� >x ^`: q�� =- -a l'1'isr ", --xo l�'itf llif3�;- 3, Q4�>i ` , 33 `Se"- `:;ti`. � -
%n��3.��.�'..�.�,...a Y- •,.'kC r,�- :w .. . . . ... . . � ., ,. ,aa.. ..: - .- , �... . � •>' +� '•fie, ,
Job site address: )7[, S g S 1'V i - eir) br/4'►G/ 1 New dwelling area: 2_47 square feet
City/State /ZIP: �I�,(3 a p1, C/ , a,-� " ` r ) Garage /carport area: 11. 5 square feet
J �
Suite/bldg. /apt. no.: Project name: ,la Nis-}0... Covered porch area: 3 2_. square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
/
Ms y , r :" r
ti4VREiIYiD :A.16- OI4I1VIERCTAI -EC ° IST Nm
-Subdivision: ------ )40.. \NSACk Lot no.: 2 Z Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.:
N
G A ; f q > ^\ equipment, materials, labor, overhead, and t he profit for the
. F a DESCRT pN4UT.l4O �. '; work indicated on this application.
�17 t 7 S G, .. V!? 3 U
t Valuation: $
• 1� 1 t i U.
, / Existing building area: square feet
. ► 1• New building area: square feet
_,,. ;,,, . _- .r Number of stones
... PROPER'1'rX, ;;'.. �, �;+ ��,„;" ,� , ea� °ilN:rt� >:: .,
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Name: �1, � V- P;4�`7 i U e_ (- If,'n'l.F `.� . -- ��v'lG . Type of construction:
Address: I G'
f 7' ; AlVl{ A't'b'1 1 4 (2 ,- 1- 'r t� --- # z c'� (J Occupancy groups:
City / State /ZIP: ��>c' i� V .64- YL or__ ' -7 0 0 (..,7 . Existing:
Phone: (`-0'!.. to 9 - C ci o z Fax: (SO -?5) 1. C(0 - 2_ `i 4 2 New: '
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Business name: j?_i V-. y 51 eL - / ( (.yt , l 5 - - -r - - - >e - C.- All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
l L- 5 a "'y e2, c.{ under ORS 701 and may be required to be licensed in the
Address: 1 C y 0 \ t w Aryl t,, • L t p y,�� ,���t :2 L jurisdiction in which work is being performed. If the
Ci City/State/ZIP: ' c- r cV . a ' t " j applicant is exempt from licensing, the following reasons
tY lj' ,, ma 4-,- y l� L/12 e;i `7 C' 0 c„, apply:
1 Y
Phone: (e-:. ) ,, L4 `.- - U C & C<"„ Fax:: (c5 ( cj 0 - e " l t Z
E -mail: Cu-riL{.L( --c) r v i'7a (4. . ) 1l'll14 X(' — ( ( 1.1
.:f* :'•3;; 1 , ;";,t �,: i,'1:� ^iAY<, " ^," y .` g � i a. O i ,.,, : .>� L n .... C' „•,, .:,x3'r�:�;>:.> ^,...,_,;�vg :
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. 'n..,�; „�3AR3,,.z:4.,2s s_�f_,xS,N:`. .......s,-s,..,..:`. :, -; ,.. - >, .'s „s.w,. li. u1'k , • 'Li Business name: �- ° ' r=
E ,mil 7 1 _ P Y I IllING P = . , . 11 : FE E $ v '
Address: /� - - �., � .:. �m.__ �: � ' - „ - <> :a; oat
Z 2 1v V ' �f trr �'7 Y'L � t .. % P � � ,A -1.) ,.. ! ? u '1(C 2C C> Please refer to fee schedule.
City/State /ZIP: 1,j? I- V .e- F' ten/u 0 ei, e — 7 e;7C P" Fees due upon application
Phone: ( i . ,?,) 42 [ (5 - C cl 4t, i Fax: (c r�-aj) C y Zj- 2 ii. Amount received
CCBlic.: 900 65 •
Date received: '2/_ (
Authorized signature: ( ' 7) , , - n.1,6,? , ,.t ._, ( P ") This permit applica ✓ ti6n expires f a permit is not obtained
X within 180 days after it has been accepted as complete.
Print name:A -L.6, 4` (')2., i t g ' Date: l2 - 212 - C)(.. * Fee methodology set by Tri- County Building Industry
Service Board.
is \ Building \ Permits \BUP- PermitApp.doc 12/03 440- 4613T(11/02/COM /WEB)
. Plumbing Permit Application FOR OFFICE USE ONLY .
City of Tigard EE1 iew 3 pemtit No 13125 SW HalBlvd., Tigard, OR 97223 O V Phone: 503.639.4171 Fax: 503.598.1960
a Other Pennit Nn.:
1 DateBy:
24- Hour Inspection Line: 503.639.4175 `f I Date ReadyBy. Jury See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: J B Supplemental Information
� �,_..f z ._. , ". <.... TYPE „OF. WORK. _,,.�� > - .. ,,,,, ,,;, „ _ .•:. �FEE.:r.SCHEDUIE =
For special information use checklist.
JJ New construction ❑ Demolition
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
�� , , >. t,,,:. � C .TEEG,92 OF: CUNS'T <: `« ;= - t,; SFR 1 bath 24
�? ° . ..... ' . ...... . ..<.<._ ..:- �_�..�: «.����o <k.c> Uzi:' �-:. 3�- �:.�„. =,z��`�; - `,i�'" () 9.20
[t 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 :311 -
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
; . gi p;• �� > ,,,�x,� r _-_ '�:� aas 3s�.� >,, •� _ . - ,,. _ s3,»:: .� - Fire sprinkler ( sq. ft.) Page 2
- - JOB SI'T'E' INFO AND LOCAAION�
�
. <.. . <,.. �, a% � S t iff
Job site address: / („6 5J bt Catch basin or area drain 16.60
City/State /ZIP: -` a �
Q a
, j O e. o, L.4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name:`\a \t , SO4., Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: e."a V fO Lot no.: 22 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
_ -.� „, Absorption valve
r. 'e3 .\'...- .s -,= ,t° '.. i?4;::; ;a,: yr �"•'3 ' 9 ,.
Orptl
; h ,.; , vD E SGRI PT3C?N F ® RK = '' '('` q
s, :v,
=� �, ._, �� �..,, - :.'f , , - :__ _..- :;_...,.�, � ,,.,,,< � .m ... ,.,� - - � , g „ .: ", .., �s „ 1 ":4' , ,.,, Backflow preventer P Page t
Backwater valve 16.60
Clothes washer f 16.60 1 b°
Dishwasher 16.60 i (, 62 Q
„1 ; .;i; Drinking fountain 16.60
;' `< EROEERTY� .O , p
TEa re . , _' !. 12:
�` `' y � � �' '� _ Ejectors /sump 16.60
Name: i•..�1 tf../,/y -,, =,i O LP_ 14'<. 2.P` 1 - t , Expansion tank 16.60
Address: IC12.5 N ,{{ .- n j 1 ? Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Garbage disposal i 16.60 16).&o
Phone: (Z--,G2i c - b`7 cz Fax: (, c)^_2) . t'l L'7 --.? ei Li 2.
' :- ;;c u „ , n »:r f . ». a ,, ::::.<., Hose bib 16.60 . ; y >Al'P IC 'I n : * ins CUIYTA REItSU T"
Ice maker I 16.60 I(o.VD
Business name: u, 1 ,,, 49 „, f); CL j4onte <� i T., -lC Interceptor /grease trap 16.60
Contact name: Al (,, fs ,--- yz __ jut c=UtA Medical gas (value: $
Page 2
Address: i q `J /,,V Art'1 i t7 ) .-.. 63 2,,. p z Primer 16.60
City/State /ZIP: J J Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 3 16.60 (t.G( . `-( i
E -mail: Urinal 16.60 tt
CQI!IT32AC[ R.. s:
„ „ 1� � „_� Water closet 16.60 �\
> .. .a..... , in:� ,�� = '�.ro.�a�'�aS: -+ �. •;,�. „ =i:� " �'�'... » ;,'�%.;_,. - , � ... .... ,..r'tt',��ti�<- � � 1660 � <'� �� V
Business name: `j`; rp,y,tel1 ililc 01V kill k.)lnlc Water heater 16.60 16,, 1( 1)
Address: S DS • S • 1;,,/ . tic, v� - _ b / ' L Other: `�
Subtotal
City /State /ZIP: 4 �ti (o Olt e) 700
Minimum permit fee: $72.50
0
Phone: (5 ) 0 - 1, 6s 7 Fax: (563 ) 3,17 Z - 95 3 Residential backflow minimum permit fee: $36.25
CCB Lie.: j 4' 2 ( ( Plumbing Lic. no.: 3 - 3 p 6 Plan review (25% of permit fee) f , - ., ,
Authori signature i v State surcharge (8% of permit fee) ,� , .`
TOTAL PERMIT FEE k
Print name: 3-dn R44 8 f' i I I Date: 2 - e_. 05 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 \PLM- PermitApp doc 12/03 440- 4616T(I0 /02 /COM/WEB) C
Mechanical Permit Application FOR OFFICE USE ONLY
13125
' of Ti and Received j '� ���
S W Hall Blvd., Tigard, OR 97223 Plan n d 7, Permit No
Review " Other Permit.
Phone: 503.639.4171 Fax: 503.598.1960 I ,f Date/By:
Inspection Line: 503.639.4175 ■ ELI Date Ready /By Juris. 0 See Page 2 for
Internet: www.ci.tigard.or.us ` " ""
g Notified /Method: Supplemental Information
.. � x .p. ^. , ... , ,.a ^:. ,,.;,M, 3Y; v :. ,�,. �ti ::,C.& „- .y�.,:.a �n3;'
.� x .. �, _: k .. >,.,.x,.K, -.. ,.'TYPE<�gF: -WO - '_. _.';FF':”
. , ..,.�..,.... _.- ...�. -- �. �, RK,� „.•J� � ”: `'�- COIYIIYIERCIAL E* °SCHEDUIE :li1SEC iii EST
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.
,_ a
:+ ., ,z ', " C ATEGORYa:OF- .C9NSTRUCFION. ".' =N` *, i
x,. '' .s .. ,. .¢.. . ,. - -..- ...... x.€ . ,. � >,�.t�a� -.dam -.��,� ;. .. _.... .- ka�'a €, %;
., _. . _ m x �: - ,.�.R�ESIDENTIAI,�E UTPMENT��SY��,EMSFEES *'';°
...<x>.�.�,a,,, =kx:. = >:'e�, .�.,xa A�'.e` ��.��.-_- .��., -.• _- sfsxbavn >t
® 1 -and 2- family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
' r�, � •�r -�,. >. IU , ,v.
OBSITE INFORMA�?1V ':A1�1U : =: LO+CA'I'I Ht
ON-` ".'r "'' � -<r',� w�'.a eain coolin g
Job site address:
f iu $ � -w.,. >r��- ,t.:,�r.s:......,... ��u.�,...... .... „�ea�•, saa »,�,,, '�;,�: ' Heating / coolin g
�p 5 �j w � - ?rd4 � Air (requ conditioning es ho heat pump
( ir site plan showing placement) � 14.00
City/State /ZIP: "t"tQA , 0 j L4 Furnace 100,000 BTU (ducts /vents) 14.00
J Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt.no.: Project name: .�e`tOs Gas heat pump 14.00
Cross streetldirections to job site: Duct work 14.00
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. 10.00
Subdivision:' (� v, S -�'(,� Lot no.: 22.. Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
__ _ W ater heater I �
+. �„ � ,, . ate ea � 10.00
_.. ,.. ...x.x. �'. �, . ,,,,, ,, � DES'Citl � U,N, OFtWORT:a
Gas fireplace J 10.00 J
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
- _•;- : »,, :k = = =_ Chimney /liner /flue /vent 10.00
�_� ...:: ::::::.:.�❑� "ERQP ^ - RT'I'�i,Q R „�' ) :..: �° >x 3x '111A1VT�;;
Name: i red `a1 YvLe3 ,, � Environmental exhaust and ventilation
g G' ✓ q Range hood/other kitchen I
Address
� ! :7 i� �: � 'Y 1 L ���il CJi # zoo equipment 10.00 JO
City/State /ZIP: ) C Lc V . 1 fry t 4 J �/ C (� (P Clothes dryer exhaust I 10.00 j —
Single -duct exhaust (bathrooms,
Phone: (Gb ) (,p — 0 Fax: ( ) v ' 2?'-/ Z toilet compartments, utility rooms) 3 6.80 '20 &1U
`;� _ ,;;-" "` en a'o-',:;a•, „- :,z,;- .,�d ru' ,
°- � Attic /crawls ace fans 10.00
� .': R' ....: �c` �x.i,��, x. D� C� �AGT''PERSON � �^ P
'+ , "'7 , ' (3 ',; '• .�E�csa�> -, `..- n"..o, >..'`.;1r,` -tea „f,
Other: 10.00
Business name: J2.i V. �Y ,oLC' EbY1&lL3 Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: )!y a n_��t t� Furnace, etc.
/L/V / r�� ” �t c^ 1 !- K) 2o L Gas heat um
P P
City /State /ZIP: �PJ '/ 700 (c7 t Wall/suspended/unitheater
Phone:(,) (I (. j 5 C9�7 E tQu Fax: (C I ,) (7 .. Z t4 7 Water heater
Fireplace
E -mail: a,iY t) / r 'e43,&CXJ'1oyliti - C: ct Range
� fCVe„.f 3' >-
B arbecue
, ,rr;i ^23, .$fir B r
��U,NTRAC i'OIr =s,L.�; »,, r JJ `*' e' •? � x ,i : �•n a b
as.,F ,,..., s, �_.- - "-�,. y,r" - =�. ..�..�.,. ;- ..,_.�•.��.c.�. � -,a,. .. .
Business name: l - L. , Clothes dryer (gas)
Other:
Address: � ° L 3 - AJ r ' I . - ;';'�': xt::: :, ; ,v, x ;>• 'gxsyr..'A'„ .•txrvxe ,
1 ,, c, . - o_ � � ._. .... r � �= : ME�HCAI: �ERIYIIT`FEES *;y
✓� a `a � rl..�' ., '�a� >XistiJA�:~',�. ug'��_ - -: ?:e = �.,. .,
City/State /ZIP: ( p r, Subtotal 11 . Lf ( j
Phone: (<a J) s t y' <� S Fax: (c ) <. r ) _ . -. _, Minimum permit fee ($72.50)
Plan review (25 % of permit fee)
CCB lic.: j y :, j 3 State surcharge (8% of permit fee)
TOTAL PERMIT FEE (; .
Authonzed signature: � �� This permit app expires if a pe is not obtained within 180
� days s after r it has been accepted as complete.
Print name: ` rF r Date: OZ J * Fee methodology set by Tn- County Building Industry Service Board
r\ Building \Permits \MEC- PermitApp.doc 12/03 440- 4tt7T(t t /02 /COM/WEB)
Electrical Permit Application :- -,'• - -..- -- .,'---, - • ,:':...FoitioFFic-Eur
City of Tigard R c e lv e - 3fr5 o 677- Permit No.. / 4757a . Arl... CX
13125 SW Hall Blvd., Tigard, OR 97223 Han Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
Inspection Line: 503.639.4175 j L ., -e-1 I - - Date Ready/By: hris el See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
„7,,.... i :; ;v:„.',. .., ',!:;,.: - :::, .4i, ',4j,,i: t ...;, --:,:,;:; :., r:,;'
I New construction E Addition/alteration/replacement Please check all that apply:
OService over 225 amps, con-u El Hazardous location
0 Demolition E Other: . OService over 320 amps - rating 1:1 Bui king over 10,000 sq. ft.,
c.kie■ziiii , of I and 2-family dwellings 4 or more new residential
] - and 2 dwelling El Commercial/industrial El Accessory building Cli System over 600 volts nominal units mono structure
Building over three stories ['Feeders, 400 amps or more
0 Multi 0 Master budder E Other:
fl Occupant load over 99 persons pManufactured structures or
- --'40B 'SPLE'"INFORMATION DEgress/lighting plan RV park
00ther
,Job no.: Job site address: ( 2 , s 12,, 6 4 1ea Ith-care facffitY
mit 2 sets of plans with any of the above. '
City/State/ZIP: -r, 5cArc 0 if, CL
, ao 4 The above are not applicable to temporary construction service.
6:-,W' ;11t11:94PEt:SclitP4E
Suite/bldg./apt. no.: Project name: (in .,wirr.,.... Description Qty. Fee. Total **
Cross street/directions to job site: . New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 1 145.15
V I'
Subdivision: \ ef,e, %.\-0••■• Lot no.: addl 500 sq. ft. or portion 3 33.40 i 001 7C) 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
6E Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.ERTY 'OWNER ,', -',''''''''',':- -',- fi , ,,--,, - - _ RI TENANT :..'. -- ,i. , ,,-T'- 106.85 2
5R „.,:, . 5. - ,I%,_' - ‘., ,' '''',?,, , , ,-=', - ' 1 ' . - ' , '" , "- ,,, - 4- - -, ' , '" - `, - k' - ' - , ' ',• ' '''' ' 401 amps to 600 amps 160 60 2
Name: 2: v,,, )« ) ( ... ,±:, , ..T..1,-y-, 601 amps to 1,000 amps 240.60 2
Add Over 1,000 amps or volts 454.65 2
ress: H 2 ‘,,,,,; m , v A, i,.. Le„,,... 1 )L ,,,_ .. i ,,,,:, 6
Reconnect only 66.85 2
City/State/ZIP: 13 , G kAt y h:-.,...--, 0/2- - , - 7 (.1) Li (4 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (GI;t) ) t y , % i - - f .1-5 - ( ; , ' ` i " . (._,:, Fax: (g•.) &-; ‘ 0 .2!: Li a 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
,.'„,,'4,14 : A. Fee for branch circuits ii
;:1-...4';`,„,,..._,., -,',. ?"%'-': , ‘ , ,. -, , .' .i
service or feeder fee, each
6.65
Business name: - 2
12 vriy i e , - ) st , _ - . o rkut . 3 - . 1.1( .. branch circuit
B. Fee for branch circuits
Contact name: A (..„_:, ,__,,,,,,,,„. A4 ev ., A without service or feeder fee,
46.85 2
each branch circuit
Address: ) 1 1 :1 &I Ri A7 1 ,,,.).itc, ; A 2 () (2) Each addl branch circuit 6.65 2
City/State/ZIP: P e l _ _,,,,_, 012_ 77- , , oc ci,.0 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: () ( .e: (. 5" ..0c7 t, 4., Fax: : ( (1" r - 1") ) 6 90 - 7_ c.- 4:7 Sign or outline lighting
53.40 2
E (A. ) r i 1/ - .516 , {_s1,1 kk:/i'l.k.a , C c-' )- Signal circuit(s) or limited-
*,v,,,tiatagstegryzfir.qr energy panel, alteration, or
extension. Describe: Page 2 2
--
Business name: . . , .
ge ffle. c...tr -c.. Le,c.,.. . . Each additional inspection over allowable in any of the above
Address: p 0 a cr ,, - 3 g y Per inspection 62.50
City/State/ZrP: 0 01 .1. 0 4,j . C.) r: 9-9. o7-o Investigation per hour (1 ht min) 62.50
.*"-- Industrial plant per hour 73.75
s _ 3 ss,--• Fax: (A53) . 6 7 I? - 1 l 0 $ ':.:
GCB Lic.: 2,0 rif Electrical Lic.: 2 (,/,..., Suprv. Lic.: '3) 4 z SI - Subtotal 2,_ 14 G, •G
Supry Electrician signature, reiptired: 'jgeetrf2L__ Plan review (25% of permit fee)
State surcharge (8% of permit fee) I I , ' ..
Print name: r*
le au ;4 6 g.e., t..-a. . Date: 2/2/ c) s-
TOTAL PERMIT FEE 7 # 35
Authorized signature: •
This permit application expires if a permit is not obtained within 180
----- days after it has been accepted as complete
Print name: rDate: * Fee methodology set by Tri-County Building Industry Service Board
_ . _______
** Number of inspections per permit allowed.
1: \ Building\Perrnits \ ELC-PermitApp.doc 12/03 440-46 15T(10/02/COM,VEB
A
Electrical Permit Application FOR OFFICE USE ONLY
' City of Tigard Received
or /Ay Permit No.: ( 003 al
.13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /41 :144#i0 Date/B : Other Permit:
Inspection Line: 503.639.4175 ,..411,... t-I 1. Date Ready/By: Juns: 2 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
,„. '''MR
iniXew construction 0 Addition/alteration/replacement Please check all that apply:
P
Service over 225 amps, comm'l DHazardous location
Demolition Other:
1=I
, ['Service over 320 amps - rating LIBuildng over 10,000 sq..ft.,
Pry, ikiiaggiliiffaiiidiiiiVbilleiiiikiiiiidiroRtt! of I- and 2-family dwellings 4 or more new residential
1 - and 2-family dwelling ID Commercial/industrial 0 Accessory building ES over 600 volts nominal units in one structure
P Building over three stories ElFeeders, 400 amps or more
D Multi 1=1 Master builder I=1 Other:
DOccupant load over 99 persons 0Manufactured structures or
til''‘ DEgress/lighting plan RV park
/ 0111Health-care facility 00ther:
Job no.: Job site address: i 2/---A.,--,-1,' -. W /2-oribr‘e-2.--di it 2 sets of plans with any of the above.
City/State/ZIP:" 1 V6/1 On, 11 2.._ The above arc not applicable to temporary construction service.
/ 1 1 / , Ritrgilf -: S3'..:' , :` -- 4 -' ,Ptt,1$7e, StitiAitter'-:',ItIreil 41r;
,
Suite/bldg./apt. no.: Project name: '10- L v 1 r_-„--
Description Qty. Fee Total **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 /46 4
Subdivision: Ppe.t (4 V i S----1LJ .
Lot no.: Z. Ea. add'l 500 sq. ft. or portion ' 33.40
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
))007:041,0*;i01.*4*,,'.4;i Each manufactured or modular
1 _ - C1A) VO J flap OCtC'h / c 6C, dwelling, service and/or feeder
Services or feeders installation, alteration, and/or relocation 2
200 amps or less 80.30 2
`,...! iii 0-co.'1 . ..: , , ,i s itati 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: y ■14
) .il6j(1,e, 0
J j I I1(_ I1(_ , 2_00 601 amps to 1,000 amps 240.60 2
Address: Is-- Ait,t) /4' L t (,,, pii,tAiLi Over 1,000 amps or volts 454.65 2
Re,connect only 66.85 2
City/State/ZIP: la VOK ' ( - q - 7 0 (.., Temporary services or feeders installation, alteration, and/or
Phone: (Str3) tag 5-b b4 I
c ,-, Fax: (9'" iu- ) L/C: 2_C c..-1 2_
! relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
r3;,::;:',MINJ _1_0(14#06:570'1.1. :1::::,VIlyjii,(07:071WA! A. Fee for branch circuits with
service or feeder fee, each
_Business name: 12) vf zy -,,-:i 1-tm --) J . )„ _ branch circuit 6.65 2
" B. Fee for branch circuits
Contact name: . /1161 . A/1 : 1\it '• zo 0 without service or feeder fee,
46.85 2
ri 7
1_ . 5 -
Address: - : ' ,--) 7/ I 07,,i4,4 i'
, __ each branch circuit
Each addi branch circuit 6.65 2
'fl • ./ .. .
City/State/ZIP: p?.tgti eyr / 1 / / :!, L - 7 6.)0 (.(.7 Miscellaneous (service or feeder not included)
Phone: (
i __-- Pump or irrigation cirtincle 53.40 2
g Lc)//
i _.) u' i Fax: : (93) 6,,6) (../ 2.... Sign 4 -
or outline lighg 53.40 2
E-mail: Signal circuit(s) or limited-
::::SAIMINIMP:ArNIF ..Q*L. 1311,',;.,,a,g:Pf:::,,::15%,41:::,:2E:7,.:,::, energy panel' alteration or
i - extension. Describe: Page 2 2
Business name: i i/l/ille,,, 0/miair
, i 4e- i iiii
Address: I 15 .
2- Ci Each additional dditioal inspection over allowable in any of the above
/ Am/ . /et Pro4/ q Per inspection 62.50
City/State/ZIP: /II Vei(-1-n1 / a (j)�, i e 0 (....( i Investigation per hour (I hr min) 62.50
Phone: 9 ' 5 v() ' .
City/State/ZIP:
Industrial plant per hour 73.75
Fax: ( Cl . )4-2-- iomiT,,AtiviiikzigQ:Ifila
CCB Lic.:16)V5 - Electrical Lie.: Suprv. Lie.: Subtotal 2/',
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 70 , crt.)
Print name: Date:
TOTAL PERMIT FEE Z.L
A 4
/ - 4
Authorized signature: aki ,,,,,, , . (_a) This permit application t has b if permit as is within 180
c
Print name: /47 (' i 3 ///1 441 Date:// ii4, d-s . Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
iABuilding \Permits \ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
r.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
IDEN< >IALfrWO
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
[Burglar Alarm
Garage Door Opener*
FV(Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
❑ Other:
E COMMER :W,O *K QNLY ' y 7 1»
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermitApp.doc 04/03
. . q Building Division
One & Two-Family Dwelling
TIGARD
Fees Checklist
- itERNIITilli$M0kMATION:'.. :; .
: r,_:;.,''';':,-•:; :'.:'::.',:.': .. ',.,:', ..:•:
.. .,. . . ,
Permit #: clW ,: - C c;), Plan #: A 7D '01 2 L Date: 9 '7 •
• C'
Site Address: ID c. EB r,--4,.c.) Q._00-, ( 017-- , ,,, t -ci A- L.. in Parcel #:
Subdivision: p- \\.c, V 0, Lot #: '4_ Zoning:
Jurisdiction: ' - 0. Setbacks: Front: Rear: Left: Right:
Class of Work: ' • k 1 p LO Stories: a First Floor: 1 t3
Type of Use: 6•F Height: 3 Second Floor: 1 -2 , t - 1 E t
Construction: E-2-, Floor Load: • bC) Third Floor: . • • - , .
Occupancy Group: i Dwelling Units: k Bonus Room:
Valuation: , . L :3 1 -A , (7n,q, \ ) Bedrooms: `f Total Floors:
Bathrooms:
:.----3 Basement:
r_l_ L . 5 c i
Decks: Garage:
• Porches: 60 cl' Other: •
Balan .„,.„ •:. . ._...,
,.•FE :: . : :, : :::':::. ,I)46iiiii:Oni: ::,."',::_ :,. .,p0:::'
Plan Check: Building: 95-4-37
Extra Set:
2
Permit: Building:
_41,
Tax:
Metro CET: '-3t=4-6 1
School CET: at-1 7c, OC)
Mechanical 1 ' • 0
Tax: • - i . (C 8
Plumbing: e--;( 9 .
Tax:
Electrical: ',- 7 C4 ..--) 5
Tax: :,33 L-V.5
Low Voltage: 19 -- .0
Tax:
CDC: CDC Ping. Rev.:
,_ ..t..
CDC LRP Fee: L A t4 CO
SDC: Parks: C 5 C
TIF Res.: 77) - 2_C - 0 ‘ 00
TIF MT: 240 . 00
Erosion Permit:
Erosion CWS: it-,
(-) b
Erosion COT: • ,g .
Water Quality:
Water Quantity: )C i d 1 5 , CO
SUB , Li Li - 7 .,,F--)3 1 L t Vi‘ 7. 53
Sewer: Permit:
Inspection:
SUB-TOTAL:
• TOTAL MST & SWR: • -
1: \Buildin \ResPlanCheckFees.doc 01/19/07 Page 1
PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment /systems)
Description I Qty. I Fee(ea.) I Total Description Qty Fee(ea.) Total
New 1- & 2 dwellings . • • Heating /Cooling • ...': (includes:100 ft..for each .utility.cohnection) ' • •' Air conditioning or heat .pump* 14.00 .
SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) 14.00
SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) If _ 17.90
SFR (3) bath ) 399.00 Gas heat pump 14.00
Each additional bath /kitchen 45.00 Duct work 10.00
Rain Drain, single family dwelling 65.25 Hydronic hot water system 14.00
Fire sprinkler - sq. ft. 0 to 2,000 • 115.00 Residential boiler
Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00
Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric)
Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00
' ,..Site Utilities • • • • . - _ Flue /vent (for any of above) 6.80
Catch basin /area drain 16.60 Repair units 12.15
Drywell /leach line /trench drain 16.60 Other Fuel Appliances
Footing drain - l 100' 55.00 Water heater I 10.00
Footing drain - each additional 100' 46.40 Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Manufactured home utilities 110.00 Log lighter (gas) 10.00
Manholes 16.60 Wood/Pellet stove 10.00
Rain drain connector 16.60 Wood fireplace /insert 10.00
Sanitary sewer - l 100' 4 55.00 Chimney /liner /flue /vent 10.00
Sanitary sewer - each additional 100' 46.40
Storm sewer - 1 100' I 55.00 Other: 10.00
Environmental Exhaust & Ventilation
Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment 1 10.00
Water service - l 100' 1 55.00 Clothes dryer exhaust j 10.00
Water service - each additional 100' 46.40
Fi xture-or Item• • • • Single duct exhaust
Absorption valve 16.60 (bathrooms, toilet compartments,
Backflow preventer 27.55 utility rooms) 6.80
Backwater valve 11 16.60 Attic /crawl space fans 10.00
Clothes washer s .16.60 Other: 10.00
Dishwasher I 16.60 Fuel Piping
Drinking fountain 16.60 * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Ejectors /sump 16.60 Gas heat pump **
Expansion tank 16.60 Wall /suspended /unit heater
Fixture /sewer cap 16.60 Water'heater . **
Floor drain /floor sink/hub 16.60 Fireplace t **
Garbage disposal 1 16.60 Range I **
Hose bib 16.60 BBQ **
._-.?
Ice maker 16.60 Clothes dryer (gas) **
Interceptor /grease trap 16.60 Other: **
Primer 16.60 Total:
Roof drain (commercial) 16.60 Mechanical Permit Fees
Sink/basin /lavatory t / ci /_ 16.60 Subtotal: $ c '''/. 7 • C
Tub /shower /shower pan ._- 16.60 . Minimum Permit Fee $72.50 $
Urinal 16.60 Plan Review Fee (25% of Permit Fee) $
Water closet -3 16.60 State Surcharge (12% of Permit Fee) $ j i , (,,V
Water heater l 16.60 TOTAL PERMIT FEE $
Other: •
Other:
Pl'uinbing..PermitFees' ELECTRICAL FEES (residential single- or multi - family)
Subtotal $ a'399 ,(_( Description Qty. Fee Total Insp
1,000 sq. ft. or less, f 145.15 4
Minimum Permit Fee $72.50 $
Plan Review (25% of Permit Fee) $ Ea. add'l 500 sq. ft. or portion L. 33.40 1
State Surcharge (12% of Permit Fee) �- Limited energy, residential 75.00 2
- g ( ) $ Each manufactured or modular
TOTAL PERMIT FEE $ dwelling, service and /or feeder 90.90 2
. . . Electrical Permit Fees .
•
Subtotal: $ ) - i . , ...1 5
Plan review (25% of permit fee) $
State surcharge (12% of permit fee) $ ., ,-
, -', .{
• TOTAL PERMIT FEE ' $
1:\ Building \Forms \ResPlanCheckFees.doc 01/19/07 . Page 2
CITY OF TIGARD
• °.
Building Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503 - 639 -4171
INVOICE
•
TO: Riverside Homes, Inc. Customer ID: 70065
1925 NW Amberglen Pkwy, 200 Invoice No.: INV2008 -00016
Beaverton, OR 97006 Invoice Date: 6/25/08
Attn: Allison May Date Due: Upon Receipt
.
GaseNo: $ife '.,.. ,. ,..:..- �...: -.,.
;: � . ubdiSision Lot;. #;or.Pcojecf:Name Aiiiount�Due`r;
MST2008 -00025 12658 SW Rembrandt Ln Bella Vista, Lot 22 $311.57
Invoice Total: $311.57
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2008 -00025 Customer ID: 70065
Site Address: 1925 NW Amberglen Pkwy, 200 Invoice No.: INV2008 -00016
Project: Bella Vista, Lot 22 Invoice Date: 6/25/08
Date Due: Upon Receipt
Invoice Total: $311.57
Amount Paid: $
Office Note: Remove parcel tag when paid.
Please mail payment to:
City of Tigard, Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
I: \Building \Accounting \Invoice doc 04/06
CITY OF TIGARD 6 /25/2008
1
13125 SW Hall Blvd. Fees Associated With 7: t 1:a4AM
TIGARD Tigard, OR 97223 503.639.4171 Case #: MST2008-00025
ro ...�; ...:: :..... ... ..u,.,... ,. ...... 7; ...
'A . '`J' ,T'an ... '.,�.. .. � .. , n�•. _... ,,i c. /} R*c.: 4ai4`i'Y: { ' ' %�v:g. ...{ei4.. zS'"SSvi - .: &- vt�.'.•.. .t :.�:'�:' �i;'E.. rv`Y
,� J,. .. jG ..t r Sup -;y. x4 4," .w` � !m„m' � .,.x�'j:' �,, s.s _ .�ffi't -.. :,xry. . �aY,�`S >„'�.. �:�. 'rk.`�. ;, � r t _,�. ,._��;,,�?�„ . Y ';'�*:tx;•::-x .�: '•` y t:, rn�,�iw
eeu '.,jam. did= .n to . r .,�a { i. „. 4,
9444 s ,• .re r Me e 5{�; $src. ~, 'F.S.' .�,': - +:r., s ..t, rs. t� �.1d'.1tilfi. ,. ^,i .;•3,,: �" . T. :t fer ,,,. -S v ' i ' .
°� � ... �F �'f:, . , E� °..d�� •r,'�kE • ��� a, �. ;r ; � a ` i ' "�u <, �..rn F ,i" ..:� 3S ..�.; : . . �' Y::' +;.., ice: �. nv � '�d2s � ,�.v <: i,
f .N ''' : °•�°'r'.••{ ,..+ ''^�`'A. 6: b -;' FrSv.: .t ,.9:s,5 ` it �`�,o-'. - ,F,? a .�', - ` o-, '�
at e: .a #e s : P ,: ; w:,. �. � .. : h . • - e .. ,' _ r r �e .:.r 3 moon �, ; D d ° e.'_: ,
: <y rN <� - .- .x - - +�� "`se�tr' :rc' y• , y�• ;a. _.?s � t.,.9�., C ilt)i _��',�,.. n, .t, ...... .�..; ..i. . .t ,35 ,�
,r �
. ,. . k; .,y. ,..f 7i..r �: '� ;..5 n.:s� �n«, 'fix. - h . r..a� ?"'
.x��ta,,.. ..,. ��'•k,�T.'�•E,� Iry >�:=.�M•k.,pG�,^ ;,";... ;x ��� .,. w�z:.3� h:u;r;-_.. ... :e ;}w^'`£gr�'� x�a� �, •, :, st:;Sy+%•.���;f. `s:x'� .s.. f _ .�:." . ,,d
._...... ... sf .�. Y'�... � -Y. _. � asze... ,.. a' �f .�..��14�r.�r+,.�:.t`... <.... ,�'�;��, ?,:�"€ �✓_'�t':us�+ra.�b.�r�xa���z�.� .� " � ��
BPLC 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Deposit 245- 0000 - 433000 BTT 3/26/2008 750.00 0.00
CDCP 1/1/1990 12/31/2020 [CDCPLN] CDC Pln Rev 100 - 0000 - 433060 LS 4/11/2008 46.00 t, 46.00 �.
LRPI 12/28/2004 12/31/2020 [LRPF] LRPlanning Surcharge 100 - 0000 - 438050 LS 4/11/2008 6.00 e 6.001
BPLD 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Balance 245- 0000 - 433000 LS 4/11/2008 202.37 202.37 ;
BPRT 1/1/1990 12/31/2020 [BUILD] Bldg Permit 245- 0000 - 432000 LS 4/11/2008 1,465.19 1,465.19
SUR1 12/31/2007 12/31/2020 [TAX] Build 12% State Surchrge 100- 0000 - 207020 LS 4/11/2008 175.82 175.82
MCET 7/1/2006 12/31/2020 [METCET] Metro Const Excise Tx 245- 0000 - 229202 LS 4/11/2008 304.89 304.89
TCET 3/1/2008 12/31/2020 [TIGCET] Tig -Tual School CET 245- 0000 - 229205 LS 4/11/2008 2,470.00 2,470.00
MPRT 1/1/1990 12/31/2020 [MECH] MEC Permit 245- 0000 - 431010 LS 4/11/2008 97.30 97.30
SUR2 12/31/2007 12/31/2020 [TAX] MEC 12% State Surcharge 100 - 0000 - 207020 LS 4/11/2008 11.68 11.68
PL3B 1/1/1990 12/31/2020 [PLUMB] PLM Prmt 3Bth 245- 0000 - 431000 LS 4/11/2008 399.00 399.00
SUR3 12/31/2007 12/31/2020 [TAX] PLM 12% State Surcharge 100 -0000- 207020 LS 4/11/2008 47.88 47.88
ELRP 1/1/1990 12/31/2020 [ELPRMT] ELR Permit 220 - 0000 - 431510 LS 4/11/2008 75.00 75.00
SUR5 12/31/2007 12/31/2020 [TAX] ELR 12% State Surchrge 100- 0000 - 207020 LS 4/11/2008 9.00 9.00
PRK6 7/1/2005 12/31/2020 [PKSDC] SF Park SDC 270 - 0000 - 450000 LS 4/11/2008 5,215.00 5,215.00
TIFM 7/1/2002 12/31/2020 [TIF -MT] TIF Mass Tr 210- 0000 - 448005 LS 4/11/2008 240.00 240.00
EROS 1/1/1990 12/31/2020 [ERPRMT] Erosion Control 100- 0000 - 207307 LS 4/11/2008 88.00 88.00
ERPU 1/1/1990 12/31/2020 [ERPLN] Erosn Pln Rv CWS 100- 0000 - 207308 LS 4/11/2008 28.60 • ,' 28.60
ERPC 1/1/1990 12/31/2020 [EROSN] Erosn Pln Rv COT 245- 0000 - 433010 LS 4/11/2008 28.60 'r 28.60
WQAT 7/1/2001 12/31/2020 [WQUANT] Water Quantity 520- 0000 - 445001 LS 4/11/2008 275.00 275.00
ELCF 1/1/1990 12/31/2020 [ELPRMT] ELC Permit 220 - 0000 - 431510 LS 4/11/2008 278.75 278.75
SUR4 12/31/2007 12/31/2020 [TAX] ELC 12% State Surcharge 100 - 0000 - 207020 LS 4/11/2008 33.45 33.45
TIFR 7/1/2002 12/31/2020 [TIF -R] TIF Resident 210- 0000 - 448001 DLH 6/17/2008 2,960.00 2,960.00
Total Due: $14,457.53
,
•
Page 1 of 1 CaseFees .rpt
From: 06123/2008 12:21 #015 P.001/001
- 0 C
. 14
t
Community Development 0 '15 2
Request for Permit Action T1 GO
T1GTIGARD l ®
1 3 1
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 S \V Hall Blvd., Tigard, OR 97223
Phone; 503.718 2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: r Owner Vrpplicant Ff Contractor ❑ City Staff
rcheel, nne
REFUND OR Name: -
INVOICE TO: (Btlzil (2, , >r Ind,eidn.tl; de --1171445 / f ri
1v railing Address: J E )..1 LA/ 1'1�Y1 (�J V ���/] P /c(/(/t/ Zo
V 0 City/State/Zip: 8/ 6 i/e.17-/'71 1 1 01 C-1.* 6/ /o0 �� Phone No.: �
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
V CANCEL PERMIT APPLICATION.
❑ REFFUND PERI\IIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
REIIOV'E CONTRACTOR FROM PERMIT -(do not cancel permit). rYibT 00e. • Oc' 2s
Permit #: f..1 b S V Y ? ) iih ✓e Old -# rvISTZOM
Site. Address or Parcel #: /2 (prs 9 5Vv Let 10_
Project Name: 13e ))k_. L+ Z
Subdivision Name: P (/ G V 13 -1-A- Lot #: Z2-
EXPLANATION: V O d/1, U L 1I.1 I L / C' 0.4./
Si , � 414 (Pc..) Date: V Z ;'
Print Name: A I fli 41(
Refund Polio
1. The I) iecior or Building ( )I lictai mai nut ni /c the refund
a) any ft hitch \\ crroncouslt paid or colkcic
h) n„t more than tto of ncc land us, application fcu when an application id eyith,lraun ur caoec] tt ho any renew et tort has been ,xpended.
c) not mare Ih.m 81r ■1 of the land utu application ftc roc issued permits.
(1) not more than h +P' of the building plan runiete Ice when an application is canceled betinc any plan runless cG> >rt has ban i Npundcd.
c) nor 1111)1c than Sit " .f the building permit to: 6n. issued permit prior to any mspteuun nyue.u.
'_. Refunds will be rertti ud to the original Payer in the same moll, id in which pan meat w.aS uecit'ed. Please allots 1 -2 weeps for processing refunds.
FOR O_ FFICE USE ONLY ..
Rte to Sts Admire: Date By Rte, to Bldg _Admin: Date 25 ,
Refund Processed: Date A/ By invoice Processed: Date By t/ .
Permit Canceled: Date 6, 9,p lit 'tt-rcel Tag Added: Date Bt•
Receipt # Date \lethod Amount S
1'. Aliuddin \I orms \Re en, in.d.loe 12,v 117 /2G /u?
_ One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 ssociat
Associat
Phone: 503.639.4171 Fax: 503.598.1960 I I l\ Aed permits:
24- Hour Inspection Line: 503.639.4175 ." I ❑Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ Other:
TIDE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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. •
„1.1� 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.
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.
y4' 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.
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.
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."
AI 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.
r 2111' Manufactured floor /roof truss design details. ❑ ❑ ❑
Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore! on and shall be shown to be a..licable to the .ro under review.
JURISDICTIONAL SPECIFICS
.2 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
. Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
• . "Reversed" buildi g plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
X 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 tree protection measures as required by conditions of approval. ❑ ❑ ❑
3_0 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 \One- Two - FamilyChecklist.doc 12/03
. ' From: 06/23/2008 12:21 #015 P.001/001
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I Community Development �, ���, �� c
TIGARD Request for Permit Action .IG P
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner Vpplicant ❑ Contractor ❑ Cite Staff
{check ( nn)
REFUND OR Name: •
INVOICE TO: MUSIIICSS Of I IldiVId11,1I3 b',(4f( jci- S , J
• Mailing Address: 16 5 MA/ / bt v l- P/c / 200
V 0 1 0 . City /State /Zip: Bit'? K 'Y (912--' Gf
6 /2-6/0ef Ati0 Phone No.: 60 totc - b /
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
[C ANCEL PERMIT APPLICATION.
II dm:7m: ■ ERMIT FEES (attach receipt, if available).
0 - , )R FEES DUE (attach case fee schedule and explain below).
g REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). I TS 0` 3 • 0002 �
Permit #: rib L S VW ? I frih VQ 60 rvi STsa6 -Coo *
Site Address or Parcel #: / ZCoG 97 SIN 1; ` le_
Project Name: I e I! k- Vi S - Z2-
Subdivision Name: DP r r4 V / 5 -1.-A- Lot #: ZZ
EXPLANATION: pvod ucf wlr I to J- a /162v (-0(
a. :Or1 ,/ •'Y 4C, .
Signature: I11 j4 ...„ (PC) Date: / 7- 0 £
Print Name: A 1I riS G i/ r fifi C
Refund Policy
1. • fhe Director or Building i )Iticiad may authorize the refund nt:
a) in fee which was e•rn uarously paid or collected.
b) not flute than 811' n of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 81 n of the land use application fee for issued permits.
d) not more than 811' of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 811"o of the building permit lie ft n issued permits prior to any inspection rvyuests.
2. Ref will be returned to the original Pacer in the s:une method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Svs Admin: Dare By Rte to Bid: Admin: Dare 4425M1112 ,
Refund Processed: By Invoice Processed: Date 1 2E gAl B .• Mil
Permit Canceled: -- - ? trcel Ta *Added: EMENIMMIll By
Receipt # Date Method Amount S
I:\ Building \IB,nns \ Rey Penni,. \etiimam Rev 117/26/117