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Permit • CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2011 -00109 '13125 S W Hall Blvd., Tigard OR 97223 503.7;18.2439 Date Issued: 07/29/2011 TIGARD 9 Parcel: 2S111 DC14900 Jurisdiction: Tigard Site address: 15937 SW KREICK PL Subdivision: Lot: Project: Suyama Project Description: Addition BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 512 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 14 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total; 512 sf Value: $53,520.37 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 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. 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 5 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: N Other: N Other Description: p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 512 Owner: Contractor: SUYAMA, RYAN & ANDREA CUSTOM VIEW CONTRACTING LLC Required Items and Reports (Conditions) 15937 SW KREICK PL 4401 SE RICE LN 1 Ersn Cntrl 503 - 681 - 4444 TIGARD, OR 97224 AMITY, OR 97107 PHONE: 503 - 735 -5954 PHONE: 503- 679 -6532 FAX: Total Fees: $2,322.30 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 throu! • • R 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1111111■ „go Issued By: _ Permittee Signature: [. Call 503.• . •.', 7. by 7:00 a.m. for the next available inspection date. This permit card shall be ept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. r, t a' 1 r' Building Permit Application �ssv Residential FOR OFFICE USE ONLY t ai Notified/Method: d 1 ` Received 'J Permit No k, t - City of Tigard ��L 0 5 Date/B ! J �� k 3{ �� a e� ioy t 131 • S W Hall Blvd., T OR 97223 �� �� Plan Review tr ° Ph one: 503 F ax: 503 If3C1 _ Date/By. Other Permit: TIG Inspection Line: 503.639.4175 Date Ready /By pp F ��+��:'�Q f Juris: 0 See Page 2 for .� ^'r 'r. i . , Internet: www.tigard-or.gov iiIj� !NO! /n � nn d y i g c �1.� L ° ° ����� (`��, ��' �... r r ` illy Supplemental Information i _, r ..,r •.a . >.`, A`x . a: ,4,s,;;r ,. <- ..:, _ � . , ' .x< '° r te--; ; ,4 - i i' UI " , �' �:�> TYP EO .�'1'GRK "•:> � � ' :.A REDDA�TfiA�I `= 'ANDF2 ELLING= r C % K .. ,.. ..... _• . •mow ."..x..3• `A`- :'-.?' - , `Y` ".ra`s rs �.r.� C ,.t. •�+� . ._ ,�,. - ��;.�..�,�,.. -., "s ^ >• ". _ ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ai Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the = s.' T ; _,;, = 3 ::, tea;; ` work indicated on this application rx. nd 2 .,. , :. . :,,._ a,a CAT Y xOF .. C O NSTR,, TI `i`' ": ,9:9.',,, tx 1- and A 2-family dwelling ['Commercial/industrial Valuation: $ '73_ ��� , `-- - 7 ❑ Accessory building 111 Multi-family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: I E,' . ,,„ , ; ;: t>k�: ' ' a a,-' ,;gig:.. Total number of floors: :. <'a, ; "J OB SITE A ND L;OCATIO _ t : - Job site address: c New dwelling area: /�j j,7_ ware feet IS Sits) kw�tck L . City /State /ZIP: " [ t 6c } Q r . 91 7.24 Garage /carport area: square feet Suite/bldg. /apt, no.: Project name: 54„..1 0, o. Covered porch area: efi square feet Cross street/directions to job site: 1-.) t.x.1, (2 cutscu ,. Deck area: square feet T t50-: - .) H , S . Other structure area: square feet f s;REQUIRED, DATAi COMMERCIALUSE;CHECKI 1ST'4 Subdivision: <re_t �` ( svC9■ 5 Lot no.: ' Permit fees* are based on the value of the work performed. Tax map /parcel no.: s I j p C 1490-0 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the ;.r ��-i �x�' gi p° :��'�`a`" work indicat on this .� `5e3; <'DESGRI TION :OF , WORIt' =',:,'• ,� :� application. , >�r;z °'A�' _ _ -__,�- , -... a gips, - Stn �\st S r 4 -mv, Co '�riJ s-Li 6 1 bete. - retr ,�, Valuation: S 1 s i Existing building area: square feet i bo w , o 11 11 t q v, • New building area: square feet : PR OI- ERTY =� � " Number of stories: a� e� � OWNER�'�. ®'TE NANT� � r; � . :f� `�; Name: Type of construction: Address: (59 3 5,> Krtzs.,:jr., a, a Occupancy groups: • City /State /ZIP: r,5 t Qr 9'12.2.4 Existing: Phone: (S-63) 7 3' 59.5 4 Fax: ( ) New: ;;: a *. �,` ,, APPEI ONTCT, PERSON N ff '? -�. _ C RS O a > > >P R T � .a fl . a � � �'° � �� :,,z � -� ..- UILDING , ,E M ser4[ ,.,_ f . .:esx., Business name: Cam ., lit l,� CStYx C � � v ) ls[ej ',a . - : _ „ � . Structural plan re fee (or deposit): Contact name: E 6 Fri ci_Si Address: FLS plan review fee (if applicable): �Lloi S is R L,z L� Total fees due upon application: City /State /L1P: Ialvvt L r 10 1 S/gp, g Amount received: Phone: (503) (n9 -( 3"Z Fax: : ( ) ; := :- .. .,,,r ,,,:r.; =_� , .- .. z4- :: -. . E -mail: �s�S fowl N) IQW cpyl Ifo.Cl PHO,TOVOL SOLAARnPA•NEL,SYSTEM F *� -,. , '' :�< - ' V ' 4 . " - Commercial and residential p prescriptive installation of �rovs'�" 1St{ wx `�:,�'t' = . s _ 3� ' GOt N TRAC R a p, ' > :F. l - ��� >:.��,; , � "� _ �t� , ,,' =`� ,, 4, ;TA roof top nted Photovoltaic Solar Panel System. Business name: C A-. \I t o_,.. C � �- LL Submit two (2 •f roof plan with tonne etails and fire department act- •- along, ' - e 2010 Oregon Address: til l.( 1 5 G R iG¢ Lit Solar Installation Special 'e checklist. City /State /ZIP: VA Vw C' I Permit Fee ' d udes plan re • 'ew $180.00 and administrative fees Phone: (�o 3 ( of , ( 3 Z Fax: ( ) State surcharge (12% of permit fee): ` $21.60 CCB lit.: _ l ' S 9 Z . I 1 1 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained e within 180 days after it has been accepted as complete. Print name: * Fee methodology set by Tri- County Building Industry L t F e3 S Cs V\ Date: ' 7 j Service Board. I:1Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 I /02/COM/WEB) ,, Jul .26. 2011 4:44PM No.9071 P. 1/2 Electrical Permit A licati _ � F . op oil. II I. II '4. t )\ 1.1 City of Tigard � E D Date/13y; /' 9� ' T�0 / / /D D Received Permit No.: 41 " 13125 SW 1-latl Blvd., Tigard, OR 97223 Plan Review ___""__ - Phone: 503.718.2439 Fax: 503..590 2 6 2011 Date/11 : Other Permit - s I' ! <.: ,1 ti I) Inspection Line: 503. 639.4175 Date Ready/13y: runs; i • See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notiftod+t,�eiod; / f �1 Supplemental Information IyP EBiIIIM, DIVISION. PLAN 0 New construction Addition /alteratian/replacenient Please check all that apply (submit 2 sets of plans wlitems checked below): El Service or feeder 400 amps or more ❑ Building Over three stories. 0 Demolition 0 Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF ICONS RUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 0 Commercial -use agricultural tr 1- and 2- family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. Multi- family ❑ Master builder 0 Other: ❑ Fire pump. 1 7 Tasrallation of 751(VA or JOB S)fI E 1NPCIR AT1Ol�l AND LOCATION X IlON ' Addition o system. larger separately derived '13'. system • ' oa motor load of ❑ "E" "1 -2 Job no a 68 Job site address: 1 (� 3 L 10011P or more. occupancy. '�� / / ��[�' ©Six or more resider+t;al units. ❑ R.ecreational vehicle parks. City / State/ZIP: l 1�� t')a /� / / J t°. /� 9 Q /� DHcalt facii es. DSupplyvoltageformore than ❑ Hazardous locations. 600 volts nominal. • Suite/bldg./apt. no.: 4 . Project name r y . I . El Service or feeder 600 amps or more. , FFE St bVY )E Cross street/directions to job site; » ,rrtptlna 1 Qty. [ AM I rerxl 1 • . New residential single or multi - finally dwelling unit. Includes attached garage. Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4 Ea add'l 500 sq, 1t, or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WOnx ' ' (with above sq. it.) Limited energy, multi - family 75.00 2 1eQ0,i.Y7 � ' residential (with above N. R) _ Services or feeders Ingtallanon aiterati0n, and/or relocation 200 amps or less 100.70 2 TX PROPI`s tTX OV c'NER 1 1211'i~IYA 14,11r, 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 ddress: /� '""""°"' - 7 5- / "T �. r C , h. P14e'r e Over 1.000 amps or volts 552.26 2 "7 Temporary services or feeders installation, alteration, and /o City /State/ZIP: " r 17 A . p . A 0,8e, ) <9 7 a L/ relocation Phone: 653 ) .-7,5--__ j L/ Fax: ( ) ,,2/ 200 amps or less 59.36 1 Ow er installation: This installation is being made on property that I own which is not 201 amps to 400 imps 125.08 2 intent • , for sale, lease, rent, or exchange, according to CMS 447, 449, 670, and r . 401 amps to 599 amps 168.54 2 Branch circuits - new, alterat or estensiou, per panel Owner sigm ' • a'' Di -. • A. Fee for branch c with III ' PERSbN above service or feeder fee. 7.42 2 • APP ' . ACI : each branch circuit Business name: B. Fee for branch circuits without service or feeder fee. first 56.18 CD /� 2 Contact name: branch circuit Each add'l branch circuit , 7.42 , 68 2 Address: Miscellaneous (service or feeder not Included) City /State /ZIP: - Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone:, ) Fax: ; ( ) Reconnect only 67.84 _ 2 E -mail -_.-.4 Pump or irrigation circle 67.84 2 ACkOJ� Sign or outline lighting 67.84 2 CUIVIR • Signal circuits) or limited- energy Business name: r ' (. L' Bartel, alteration, or extension, Page 2 2 ! t � i y r Each additional ins i ectton over allowable in an of the abov Address: t 9 ()L/ -ry ,e l_ s pd Additional inspection (1 hr min) 66.25/ hr City / State/ZIP: /I4 y 6 ,,e_. &. A.) 9 3 Ind D I (1 hr tam) 78.28/ hr ugp plant (1 hr mitt) 78,18/ hr Phone: (may( 9 O s.-0 Pax: (5q/ ) / P ') -._ ` � / ?s -e Inspections for which no fee is 90.00/ hr 1 ��? s i6call listed ltz hrmin d k . i 7 E1 Lic_:4 /� / / • Electrical lac_: Su rv. ie.: 3 s ,. ELEMICAL PERMIT FEES Suprv. Electr�c ail fure, required: // / /0 / a Subtotal: 5 8 F lan review (25% of permit fee): --tf— . rint name: ' Date; State surcharge (12% of permit fee �m�Q ;5416 � ,�. � � �— / ( � c p fee): / t 30 TOTAL PERMIT FEE: I Authorized sign This permit application expires if a permit is not obtained 'Albin la Print name:: , F . v fr ,e S Date: -.. -db—i, i days after it has been accepted as complete. 9/A0 N€177/ /rte s9 e /L wgy &7 g 77z ' 7'�i�Y 7 i a4U - !U /t' a wei- 4/VAN i`1s7" /T, it 1V4echanical Permit Application FQIi OFFICE USE ON�.Y _ _ '^ _ Received S P� _ �✓ -A ,...„, City of Tigard Permit No.: a ., e B y : 1111 13125 SW Hall Blvd., Tigard, OR 97223 Eiv ' � t ae a tew C Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: T I G A R D Inspection Line: 503.639 Date Ready /By: _furls: ® See Page 2 for Internet: www.tigard - or.gov JUL 0 5 2011 Notified/Method: Supplemental Information TYPE OF WORK CITY OF TI GARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ ) 1leer U!V(�i1.1 Mechanical permit fees* are based on the value of the work New construction �'Addition/alterat e Y 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* W I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: i S q "s1 5 � K rcu .. k PL . (requires site plan showing placement) 46.75 c Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: -ft J I O r Q rim Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: S �� Heat pump W", (requires site plan showing placement) 61.06 Cross street/directions to job site: t p � 0.C_ 1 Ohl Duct work l 23.32 Z 3.2 Hydronic hot water system 23.32 'i H .5 r Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: f _ Lot no.: Flue /vent for any of above 23.32 K lf'4 «k �� Other: 23.32 Tax map /parcel no.: 2 S) l) b( Ittci 010 Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 a 1 Gas fireplace 33.39 S t vt t.& t 5 ti c CSzvlRnar},,� i bttd. rtr vvv. Flue vent for water heater or gas 1 t fireplace 23.32 in rOtrvIn' C I ( U t ■A_) ('! 4 0... . Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 g PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: Ry t S ovi Environmental exhaust and ventilation: S W ie.rQtQ. Range hood /other kitchen Address: 1 S K PL . equipment ment 33.39 City /State /ZIP: --r I or Gl -- 2 - Z 9 Clothes dryer exhaust 33.39 l Single -duct exhaust (bathrooms, Phone: (5c3) 13S- 5c) Sy Fax: ( ) toilet compartments, utility rooms) ( 23.32 73.32- ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Cl �, \)l (4 41 L C Fuel piping: Contact name: E. L'1 SFr te_s, ✓1 $14.15 for first four; $4.03 for each additional Address: 440 1 S E R t cQ. L.1 - Furnace, etc. ��, Gas heat pump City /State /ZIP: 0 t� I t 0 r 91 22 - I Wall /suspended/unit heater Phone: (S03) (p--/c1-‘,5 Z Fax: : ( ) Water heater `` � 1 t Fireplace E -mail: C � � % QCV ' Covi ThCTl ►'YS e pr�Ts ( o Gawp Range CONTRACTOR Barbecue Business name: •T3[) Cp.") - - 'k C c h - Clothe dryer (gas) heer: r: Address: 440 1 5E R t Cam, 1 v) - MECHANICAL PERMIT FEES* City /State /ZIP: 1111,, „.:4-(, C7 cot o t Subtotal AL,. tcl Phone: 56 3) ( ,_ ,_(...s. 3 Z Fax: ( ) Minimum permit fee ($90.00) �`? Plan review (25% of permit fee) CCB lie.: n s 9 2 c° State surcharge (12% of permit fee) IC, jt5 TOTAL PERMIT FEE (1Xi ) This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. • Print name: l . L I Fr I QS T Date: ', , 29 . ) ( * Fee methodology set by Tri- County Building Industry Service Board I:\Building\PermitsVMEC- PermitApp.doc 09/09/10 440 - 4617T (I 1 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building \Permits\MEC - PermitApp.doc 09/09/10 2 , • ' Plumbing Permit Application IQ E"IVE Building Fixtures FOR OFFICE USE ONLY City of Tigard JUL 0 5 2011 Received �, Qn Permit No.: �tdl0 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: � / (/ ��'T/� Plan Phone: 503.718.2439 Fax: 503.598.1960CITY OF TIGARD Plan Review Other Permit No.: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISVH DateReadyBy: Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE El New construction 0 Demolition For special information use checklist. � Description I Qty. I Ea. I Total 1 1A1 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 Ri I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 Sc 5 I {rQ_I dc FL Catch basin or area drain 18.76 City /State /ZIP: l U Drywell, leach line, or trench drain 18.76 � 3 o e i , O ( q 1 Z Z 1 Footing drain (no. linear ft.: _) Page 2 Suite/bldg./apt. no.: 1 Project name: S WICK -.a Manufactured home utilities 50.03 Cross street/directions to job site: pv,r1,,ewr, Rd . C ....- , • Manholes 18.76 T i t5 l � ,5 . Rain drain connector 18.76 �o Sanitary sewer (no. linear ft.: ____) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: Ie r c4. t ck 0.0(e w 5 Lot no.: 3 Fixture or item: Tax map /parcel no.: 2 S i Il ( DC 14 9 o -0 Backflow preventer 3 1.27 DESCRIPTION OF WORK Backwater valve 12.51 • Clothes washer 25.02 51 vtlk- 5 O ' r -Cl T Ccsvls6 L$t t 1 0c I 6ar.5? J Dishwasher 25.02 i �jp..1 h r GJ i1 J t' 0-1 o,.. Drinking fountain 25.02 Ejectors /sump 25.02 W PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 ? Sw. Floor drain /floor sink/hub 25.02 Address: ic 31 c kaL,ck P L " Garbage disposal 25.02 City /State /ZIP: Tl5 Q( 911 Hose bib 25.02 Phone: (Sb3) 13 S- 59 S Li Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Ct l�Rlw, v,tCt l Cs�..6rnek"� LLL Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: EL■ Fr ttt Roof drain (commercial) 12.51 Address: l.{ tip I 5 E 1.1( Lo , Sink/basin/lavatory ( 25.02 2. , OZ City /State /ZIP: 14 V1i. 1 Of • lot Solar units (potable water) 62.54 Phone: (SO3) (. 1 - (ps 3Z Fax: : ( ) Tub /shower /shower pan r 12.51 121 E -mail: Ctd5 v►11 IcLW GOB pC�ttr Gown Cav►n Urinal 25.02 Water closet 25.02 26,02- i CONTRACTOR ;�y Water heater 37.52 Business name: eevL1 UW r C lAtv4^NtYl q r f v%C Water piping/DWV 56.29 i Address: - .1 i o t_ , 14 &Cc>c_k J Other: 25.02 City /State /ZIP: 1V , i ( ' � az • 2 7 / .3..), Subtotal 192_55 Phone: ( 503,) 5 3 15 ,- 27? .. • Fax: `� �2 ) 5p^ .4, Minimum permit fee: $72.50 q , . Plan review (25% of permit fee) CCB Lie.: 1/0`t 41fa, I Plumbing Lic. no.: a9P6 �� State surcharge (12% of permit fee) ) Authorized signature: l td �f TOTAL PERMIT FEE I J Print name:�/ ` (s0 L ` ! '� ` fO te: This permit application expires if a permit is not obtained within 180 days i1'L Pt^ after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 46t6T(10 /02/COM/WEB) • Plumbing Permit Application - City of Tigard ` Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and includin. $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", 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 Garbage - Domestic - non -food Disposal - Domestic -food related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an 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:\ Building \Permits\PLMF - PermitApp.doc 02/24/2011 2 " Building Division Development Code Provision Review T[GARD Residential Projects Building Permit No: t ' i 9011 - DC lQ / CWS Service Provider Letter Received: Yes No ❑ N/A ❑ Routed Plans: /� Original Plan Submittal Date: 7/ S /4 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (/) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact �l (LL at 503 - 718444 or S&L e LQt/ @ti or. Land Use Case NR. Name L( tt Gk- i LLA_4Z7'A / ❑ Zoning 1 ❑ Setbacks: Front / Rear f 5 Side S Street Side 1 P Garage 90 ❑ Maximum Building Height 35 Actual Building Height ❑ Visual Clearance ❑ Easements V 556 ❑ Sensitive Lands Type: VI v- Notes: Original Plan: Approved d Not Approved ❑ Date: '2(5 (1( Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) Actual Slope: '- Notes: Original Plan: Approved Not Approved ❑ Date: 7 5 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) l Street Trees 0 Protected Trees Notes: Original Plan: Approved LJ Not Approved ❑ Date: 7/5 q Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @ tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes V No ❑ Date Routed to Building: �� Page 2 of 2 -- N 8 °51'40' E -- -- —\-- i i '\% (bS ' - - -- -- -- -- -- -- -- -- -- r -- ' 50.00 — c s I ♦ REMODEL AND ADDITION FOR: 1 MR. 4 MRS. SUYi4 1931 SW KRE ICK PLACE R CVED \ TIGARD, OREGON 91224 I ` JUL 0 5 2011 \ TAX LOT: 1 - SIII Dc-- 1 " °13 CITY OF TIGARD I ♦♦ BUILDING DIVISION 1 \ 1 ♦ 1 \ 1 ♦ • 6 _ __ _ _ _ ♦ _____ _ I \ = 6 NEUJ COQ/: VD PATIO 1 Q ♦\ 1 ■INIE■•■■. IP N w 22 v l 0 T `n` \�' 6 r AtairteSERS:IZOMINNIIMMII■ %,) Z1 ZI NEW PATIO �c', f E P ♦� I • Igo' - , \ I I \1 \\\\\ ' 411 I. I '.1. OE [%. D N ``.` \ I ` \\ ∎■ ` .:sue , 9 1 --- 9 �\ /�.„F 1 . ``. \ 1 rT W c r l a 1; NORTH ` 1 2 \ Z 1 % , I SITE FLAN ,`. SCALE: I/8" = I' -0" 1 _ © � 1 This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. IN City of Tigard Buildin g Division TIGARD TRANSMITTAL LETTER TO: N DATE ' 1' (Pr, 114 . DEPT: BUILDING DIVISION JUL 2 7 2011 CITY OF TIGARD FROM: feg y - s' BUILDING DIVISION COMPANY: JOk / ,4/r7`7i t ES (6L2 / l � /UG PHONE: � --A�Z By 7 RE: /5937 a4) /4e/c.41 M5i Nu / / -ea /a9 (Site Address) (Permit m , er) Ssa..y9 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and /or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: FOR O FICv USE ONLY \---:--, Routed to Permit Technicia Date: - 7 (2 ( ( Initials" *`XV Fees Due: 11] Yes [1-J' I oo Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1:\ Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011 • This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. � City of Tigard "� = Building Buildin Division TIGARD TRANSMITTAL LETTER TO: . �4 w' /✓ELS' p DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: -, \ tgvJ C-C-410-ck` `t , 'JUL 1 4 2011 COMPANY: E L% CITY OF TIGARD BUILDING DIVI, 'vN PHONE: 503 C���i 3Z By. RE: l �s3 �' � - /C/t /t'1Sf J// 0(�/O (Site duress) (Permit Number) (Project nam 1 or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): 772-,s $ REMARKS: FOR OFFIC USE ONLY Routed to Permit Technicia t : Date: `7 �'(2.(23. I � 1 Initials: Fees Due: ❑ Yes L o Fee Description: Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\ Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011