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Permit CITY OF TIGARD it 1 MASTER PERMIT 1 - (� Permit #: MST2011 -00115 COMMUNITY DEVELOPMENT �� TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011 Parcel: 1S125DD02400 Jurisdiction: Tigard Site address: 6925 SW VENTURA DR Subdivision: Lot: Project: QUERIN Project Description: Bathroom remodel with new window. 8/4/11, changing electrical contractor and adding another branch circuit. 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: $19,250.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 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 Other Fixtures: 0 Drywell- Trench Drain: 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: 1 Furn <100K: 0 Vents: 1 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'l 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing. N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 0 Owner: Contractor: QUERIN, TARILYNN PARAMOUNT BUILDERS Required Items and Reports (Conditions) 6925 SW VENTURA 14170 SW ALLEN BLVD #42 TIGARD, OR 97223 BEAVERTON, OR 97005 PHONE: PHONE: 503- 403 -8463 FAX: Total Fees: $925.99 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT • 1 : egon law r quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 - %r 10 through OA' 952 -0 -0090. u may obtain a copy of the rules or direct questions to OUNC by calling 5 .. 32 ,1 19987 or 1.800.332.2344. Issue. By: , �� • Permittee Signature: C / '( - ' �" ale �r---4- o --- Call 503.639.4175 by 7:00 a.m. for the next available inspection date. (J This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application /J / Foit OFFICE I S ": ONLY City of Tigard �� FED DateB 4 Permit No.! i%p� /� 00// 13125 SW Hall Blvd., Tigard, OR 97223 " Plan Review • Phone: 503.718.2439 Fax: 503.598.1 _ Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 ��{{ BUJ 2 Q, O Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard -or.gov Notified/Method: Supplemental Information TYPE ',, !`;� I FTIGARD PLAN REVIEW ❑ New construction ❑ Addition/alteratlo rep ace , I I , 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. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: Col Z5 SW J 0_1,1T V Six or or more residential Recreational 0 or more residential units. ❑R vehicle parks. City/State /ZIP 0,1 ❑ Health -care facilities. ❑ Supply voltage for more than 0 locations. cl � 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'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) r/ C & Limited energy, multi-famil 75.00 2 � residential (with th above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'! branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City /State /ZIP: 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 '0R, s Signal circuit(s) or limited- energy � (� h - ' panel, alteration, or extension. Page 2 2 Business name: ' i' x .F t C Each additional inspection over allowable in any of the above Address: 1 tk3s s , & 'F� t ; _ Additional inspection (1 hr min) 66.25/ hr City /State /ZI Investigation (1 hr min) 66.25/ hr V , 06Z Industrial plant (1 hr min) 78.18/ hr Phone: ( ) ,133-6 701 Fax: ( ) Inspections for which no fee is 90.00 / hr specifically list (%2 hr min) CCB Lic.: to / N 0 Elect 'cal Lic.: Suprv. Lic.: 3 77 ELECTRICAL PERMIT FEES ('t* Subtotal: Suprv. Electrician signature, require. Plan review (25% of permit fee): Print name: , {1..), ■ , d Date: . 7L jZ ( ( State surcharge (12% of permit fee): II TOTAL PERMIT FEE: Authorized signature:` This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ' \ n- _ �_ Date: WPM * Number of inspections allowed per permit. , An I: \Building\Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* O Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ 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 I \ Building \Permits\ELC - PermilApp.doc 07/01/10 , CITY OF TIGARD MASTER PERMIT ` 4 COMMUNITY DEVELOPMENT Permit #: MST2011 -00115 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011 Parcel: 1 S125DD02400 Jurisdiction: Tigard Site address: 6925 SW VENTURA DR Subdivision: Lot: Project: QUERIN Project Description: Bathroom remodel with new window. 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' $19,250.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 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 Other Fixtures: 0 Drywall- Trench Drain: 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: 1 Furn <100K: 0 Vents: 1 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addl 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr. 1 Mfd Home /Feeder /Svc: 0 401 -600 amp. 0 401 -600 amp. 0 601 -1000 amp: 0 601 +amp- 1000v. 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 0 Owner: Contractor: QUERIN, TARILYNN PARAMOUNT BUILDERS Required Items and Reports (Conditions) 6925 SW VENTURA 14170 SW ALLEN BLVD #42 TIGARD, OR 97223 BEAVERTON, OR 97005 PHONE: PHONE: 503 - 403 -8463 FAX: Total Fees: $917.68 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. hose r. - - - forth in OAR 952- 001 -0010 through • = r 952- 001 -0090. You may obtain a co. . . - ules or direct questions to OUNC by callin. - : e.. 32.2344. Issued By NIIII6 /IG. / _ Permittee Signature: /t r�� f Call 503 63 � :4 7:00 a.m. for the next available inspection date. . 111"milim.'.----- This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. , Building Permit Application are, E_ ,_ , c -12— Residential FOR OFFICE USE ONLY City of Ti and Received P erm i t No. 1 3 g Date/B : -7 /ti . . i 40 - .0 / 6 ° 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review ' g Phone: 503.718.2439 Fax: 503.5 , t . O�� Date/B : Man Other Permit: T t G A R D Inspection Line: 503.639 �, Date Ready :y: . / RI See Page 2 for Internet: www.tigard- or.gov �� O NotifiedlMethod: Am Supplemental Information TYPE OF WORK , , O 0. ., REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ DerrMkiot}�� Permit fees* are based on the value of the work performed. c\� e Indicate the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Oth equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® I - and 2- family dwelling ❑ Commerciallindustrial Valuation: $19,250.00 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: I JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 6925 Ventura Dr New dwelling area: 0 square feet City /State /ZIP: Tigard, Or 97223 Garage/carport area: square feet Suite/bldg. /apt. no.: I Project name: Teri Querin . Covered porch area: square feet Cross street/directions to job site: 99W to 71 ° , turn N/W Deck area: square feet to end , Right on Mapleleaf, to end, R on Ventura Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 0 I Lot no.: 0 Permit fees* are based on the value of the work performed. Tax map /parcel no.: 0 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. removal and re tile of shower, add to walk in closet, minor plumbing Valuation: $0 relocation, new vanity and sinks, new toilet, new flooring, new skylight Existing building area: 0 square feet some new sheetrock, new window New building area: 0 square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: 0 Name: Tani Querin Type of construction: 0 Address: 6925 Ventura Occupancy groups: City /State /ZIP: Tigard, Or 97223 Existing: 0 Phone: (503 )245 4244 Fax: ( ) New: 0 ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Paramount Builders (Please refer to fee schedule) Structural plan review fee (or deposit): Contact name: Peter Groner FLS plan review fee (if applicable): Address: 14170 S W Allen, #42 Total fees due upon application: a-t2�6L City /State /ZIP: Beaverton, Or. 97005 TT Amount received: 2.145 Phone: (503) 403 8463 I Fax ::( ) t E-mail: paramount.builders @yahoo.com PHOTOVOLTAIC SOLAR PANEL S STEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System. Business name: Paramount Builders Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 14170 S W Allen Blvd, #42 Solar Installation Specialty Code checklist. City/State /ZIP: Beaverton, Or 4"--7 Permit Fee (includes plan review $180.00 and a fees): Phone: (503) 403 8463 Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lic.: 5 Qil 6 / Total fee due upon application: $201.60 ) Authorized signature: This permit application expires if a permit is not obtained _,w.1J within 180 days after it has been accepted as complete. IV Print name: Peter Groner Date: 6/27/11 — * Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Petmits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB) Electrical Permit Application ® FOR OFFICE USE ONLY r Received 1111 u City of Tigard y Date/By: Permit No.: STO( / /l"'�Jtl /15 13125 SW Hall Blvd., Tigard, ORff! Plan Review Phone: 503.718.2439 Fax: 503. '`8.1*. t '°11 Date/B y: Other Permit: Ins ection Line: 503.639.4175 1 `` Date Ready/By: Juris: El See Page 2 for TIGARD p V Notified/Method: Su lementalInformation Internet: www.tigard- or.gov ? PP TYPE OF WO� s : PLAN REVIEW ti4tlX a Please check all that apply (submit 2 sets of plans w /items checked below): 0 New construction 0 Addition/alteraSCjV "' ❑ 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. • ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", C . �q /-� tOOHP or more. occupancy. Job no.: Job site address: T 5 •.S v 41 Q 4_12, . ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ry ❑ Health -care facilities. 0 Supply voltage for more than / i � f f� % s� �'r ❑ 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: /7 p Description I Qty. 1 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 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential SS; DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 _ / I n C p� Limited energy, multi- family 75.00 2 - (7l'/ _ �G�S ;tc�l�,vS At 9 / 1sL� t�Et-1.Er,[i/ c3LL -e0 45 residential (with above sq. ft.) J (J n Y, ((� r Services or feeders installation, alteration, and/or relocation /f 1_' S �a AC G ` _ 6- G ri ) / (t. r$ 200 amps or less 100.70 2 v PROP OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 ` f � 401 amps to 600 amps 200.34 2 Name:Tac L ` tse i l v 601 amps to 1,000 amps 301.04 2 Address: k q a5 s t) \), {- ,r-- Over 1,000 amps or volts 552.26 2 City/State /ZIP: — TT �A Y 0 V — � ^1 V � �23 Temporary services or feeders installation, alteration, and /or l , " relocation Phone: ( 5c )3 ! I., _,&J- L4 Fax: ( ) 200 amps or less 59.36 1 `( 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel /lk Owner signature: (k A t A j Date: — 1 —P___.... A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first l 56.18 9 ' 2 Contact name: branch circuit l Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City /State /ZIP: 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 Business name: panel, alteration, or extension. Page 2 2 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 ('/z hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): ' TOTAL PERMIT FEE: Authorized signature: CIUV— This permit application expires if a permit is not obtained within 180 • days after it has been accepted as complete. Print name: �'�� i `t �>� v\_, Date: �1 — * Number of inspections allowed per permit. 1:\Building\Permits\ELC- PermitApp.doc 07/01/10 A. 440- 4615T(l1 /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1.\ Building \Permits\ELC- PermitApp.doc 07/01/10 Mechanical Permit Application cz4 FO R OFFICE USF ONLY r City of Tigard ,0 Recei DateBy ve : d L Permit No.: f� . ( r� - ' 13125 SW Hall Blvd., Tigard, OR 9722 cy �. 11 14 Phone: 503.718.2439 Fax: 503.598.1% V. ``\\ 1 +�� ,. - . Other Permit: T I G A R D Inspection Line: 503.639 ,V�' � N�� , ' to Ready /By: Juris' 0 See Page 2 for Internet: www.tigard - or.gov \ � o� r ,c Notified/Method: Supplemental Information TYPE OF WORK V� . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST V 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. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT, / SYSTEMS FEES* ❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: G 9z S s 14, LJe tZ_ 47 • (requires site plan showing placement) 46.75 !%/ Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: r,f. A. ® ! /Z 97.2.Z 3 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: v Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: p7 A 4 0 ,21. 2 " Duct work 1 23.32 �. 3 L !l 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 tL eV' e i 7 1_ ^ t'd0 .�1 j/ � 19�� y Flue vent for water heater or gas r fireplace 1 23.32 yz3 r 1 d� Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: T(,C I Q (A € . ' l I'1 Environmental exhaust and ventilation: p �y l 11 P V Range hood/other kitchen Address: � "I Qs nu) V � 1�Q r � equipment 33.39 City /State /ZIP - ' "1 - aro( -C' ) Clothes dryer exhaust 33.39 Fax: Single -duct exhaust (bathrooms, Phone: �'jc 3 i4.5 -4 �� ( ) toilet compartments, utility rooms) 23.32 51 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 c�- I� n Other: 23.32 Business name: 1,Q44.44,1 /J 4�-u'I el L�l I GC0h S Fuel piping: Contact name: 72� fr 6,,i 6,,i ,, i t $14.15 for first four; $4.03 for each additional !` Furnace, etc. Address: / 9) 70 51 A/ / 512. Gas heat pump City /State /ZIP: G2- f.1Ft-9i / t9Jf 9 ' O€7,! Wall /suspended/unit heater Phone: (9`9 . �) tko 3 1 VV . Fax: : ( ) Water heater E - mail: / /jars" 47-)/4.,14.-,, Fireplace � `y4,243 -gio, . ebur lpatf 'e9. ceree Range CONTRACTO Barbecue Business name: 3 t � /3�i Clothes dryer (gas) Other: Address: /ii, 7 7 5-7 ,I //�� 3/ Q *' 4t 2 MECHANICAL PERMIT FEES* t City /State /ZIP: t9 T 1 �� 71 , 97 7 Subtotal 6 . Minimum permit fee ($90.00) 4:3 ,`3 Phone: (App gd) avT' d 6 3 Fax: ( ) Plan review (25% of permit fee) CCB lic.: 9•0V z _ State surcharge (12% of permit fee) 10 , ------ TOTAL PERMIT FEE (CO , SO This permit application expires if a permit is not obtained within 180 Authorized signature: O af i days after it has been accepted as complete. Print name: ..iprn _ ` ,_ Date: * Fee methodology set by Tri- County Building Industry Service Board I: \Building\Permits\MEC- PermitApp.doc 09/09/10 440 -46 'T (I I /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 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY y �k City of Tigard S # ,a, ° � ° "' r�Q�\ Received permit No.: II 'I 13125 SW Hall Blvd., Tigard,OR 9772 3 1• Date/By: �/✓i 5-7 /5- ` Plan Review 0 : Phone: 503.718.2439 Fax: 503.598.1960 ,V� G � ate/By: Other Permit No.: �ate Read B Inspection Line: 503.639.4175 �� %`D Page 2 for T l GA R D �'( `��Cj® Ready /By: Ju ris: El See g Internet: www.tigard - or.gov C O Qr �5 Notified/Method: Supplemental Information TYPE OF WORK a �1ai\\ ` � J FEE* SCHEDULE information special ormation use checklist ❑ New construction ❑ Demolition P Description I Qty. I Ea. I Total Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 IA 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: j p r l . I (� r Catch basin or area drain 18.76 Job site address: iv l W � e� dJ City /State /ZIP: 1,8 PII Q { 1 2. Z Footing drain i nh line, or trench drain ag 2 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: 17 p fl/ Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 s Clothes washer 25.02 I f 1::1--, V ce -c ^'/ X ✓f e:24:% - /I �k b / Dishwasher 25.02 ,yt -GLr - �-� 4 ` / , A-4 12 1 a0-154 V „s1do eft gt NT &5 Drinking fountain 25.02 AI tOi.,e i • /4R-+ - t7` Ejectors /sump 25.02 .ROPERTY OWNER I _ ❑ TENANT Expansion tank 12.51 Name: i Fixture /sewer cap 25.02 1 / _ a U ' V ^ \ Floor drain/floor sink/hub 25.02 �1 Address: L a5 o 5 Q Q 1 (a ( , r-- Garbage disposal 25.02 } � City /State /ZIP: 1 0 ( '�, r - t12-1:2_ `� Hose bib 25.02 Phone: (5 (8 3,4S ) .� .__LEax: ( ) Ice maker 12.51 .PPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 0 2 , 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet • 25.02 Water heater t 37.52 Business name: (llut.,,r Water piping/DWV 56.29 Address: Other: 25.02 City/State /ZIP: Subtotal Phone: ( ) Fa ( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: Plumbing Lic. no.: State surcharge (12% of permit fee) Authorized signature a_, 6) TOTAL PERMIT FEE Print nam i(' I (J " r Date: -1 a `' This permit application expires if a permit is not obtained within 180 days 1 after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. J: \Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) Plumbin2'Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 50.03 0 to 2,000 $121.90 - Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 - Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty . Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge- 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for . Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system.. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" 4" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - food s g q g Disposal - Domestic--food related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lay - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\Buil ding \Permits\PLMF - PermitApp.doc 02/24/2011 2 Q�` NE-►J 3 c7 j „�� L u. S ken: (NV 1- *c. s czai0.) '� X z s 1p >a a ,SCI 4. v-,:, yn we - 1 G vt F i L { �J r le+ cv M v`r�' � �= Dot ■ i 1 pl ` e IM 1,,17444 e. .1 L. e 1"a ' C m J G i z /ems a'`- i c l' a., _ f V Isa r ditigit 1 7 1 R'° � m IA) e- 7 14":":/..77/ --t 5 Ni. 0,) /ve 4.4..pre,t_a4.4._ 071. .1"Ac, +ail to -' -6 1 0 ' I < - - - - , $ 6 "--?, i t , RECEIVED JUL 12 2011 J TIGARD ,/ CITY OF BUILDING DIVISION LI 1 I- / - :3 OF GA's ! Approved . . [ .:$ YI It.; � iN 0 Conditionally Approved [ ] See Letter to: Follow...i.i. [ ] T. 14-- 3 ? �r °--". Atta ed.....i..NNi f _ P6c e o i Permit N m l er 4 I By: AligarlIP Date: 'AliaW Ec -- - • 4 ith Ca.--1.--ipit,4 I 0 , 0 34?-1P 0 0 Approved plans 0 \ 4` shall be on job site. of _ *-v -� — — r 3 �` I` �� en,� OFFICE COPY — i i \N) aii,..V. 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I i I I , I 1 ,r „,,, -- ----- , I if L -------- ! --i-_-__--1---- 1 _ Ia. I 1 1 nr 1 ., iiMEMMOMMERN, I 1. 73 ? l'14')° 1. 1 I 1 , 1 e 1 I I I 1 ' - ,!iq l' II * i 1 I • _A - 1 1 I i I 1 I 1 1 I 4I k I 1 0.11 1 1 I - I I .■ k .-. 1 I I I III • _ __LH I I i III III 1 1 1 1 I 1 1 1 1 I ... 11/‘ - 1 I I I i ,.. I I ■ I 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. I or 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. Print Name of Permit Applicant t. • 7/ 5 1/4/ gnature of Permit • pplicant Date Permit #: Agr ale 00 — do ll S , ,A5 1.6 1 Address: � ��nr' " -• t d2 Tw .• . `�.� Issued by: 8-77-, Date: 7/ / ;= - This Copy for Permit Offices