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Permit
a „rt. n 3-2- d' -- a • aL' Get y , n CITY OF TIGARD MASTER PERMIT C - COMMUNITY DEVELOPMENT r- Permit #: MST2009-00080 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/27/2009 Parcel: 2S102CD02605 Jurisdiction: TIG Site address: 9608 SW HILLVIEW CT Subdivision: Lot: Project: BHATTACHARYYA Project Description: 1,024 sq ft non - habitable horticultural addition. ADDED (2) hose bibbs 6/30/09. ADDED (1) 200 amp /less sub -panel and 11 branch circuits. 8/26/09 entire addition to be considered habitable space, associated fees have been paid. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First. 512 sf Basement' sf Left: Parking Spaces: Height: 21 Bathrooms. 2 Second: 512 sf Garage: sf Front: Smoke Dwelling Units 1 Third' sf Right: Detectors: Yes Total: sf Value: $104,396.80 Rear: PLUMBING Sinks: Water Closets: 2 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories' 3 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers. 2 Garbage Disp: Water Heaters: Water Lines: Drains Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: Heat Pump: N Hoods Other Units. Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 -200 amp. 0 -200 amp: W/ Svc or Fdr: Ea addl 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr: Limited Energy. 401 -600 amp: 401 -600 amp: Ea add Br Cir. 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System. N Garage Opener: N All Other: N Other Description. Ecompasing: N BUILDING INFO Class oflWork: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) KEYA BHATTACHARYYA OWNER 9608 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $2,909.45 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344. Issued By: / Y� Permittee Signature: � Or ‘. lVrYCJ k) r CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009- 00080 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/27/2009 Parcel: 2S 102C D02605 Jurisdiction: TIG Site address: 9608 SW HILLVIEW CT Subdivision: Lot: Project: BHATTACHARYYA Project Description: 1,024 sq ft non - habitable horticultural addition. ADDED (2) hose bibbs 6/30/09. ADDED (1) 200 amp /less sub -panel and 11 branch circuits. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 512 sf Basement: sf Left: Parking Spaces: Height: 21 Bathrooms: 2 Second: 512 sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: Yes Total: sf Value: $40,134.08 Rear: . PLUMBING Sinks: Water Closets: 2 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 3 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 2 Garbage Disp: Water Heaters: Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: Heat Pump: N Hoods: Other Units: Furn <100K: Vents. Woodstoves: Gas Outlets: Furn > =100 K: ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp' 401 -600 amp: Ea add! Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amplvolt: 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: Owner: Contractor: Required Items and Reports (Conditions) KEYA BHATTACHARYYA OWNER 9608 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $1,243.17 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .246.66699 or 1.800.332.2344. Issued By: ` Permittee Signature: \ J� L c(-�1` r Qt V to add CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009 -00080 • Date Issued: 03/27/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102CD02605 Jurisdiction: TIG Site address: 9608 SW HILLVIEW CT Subdivision: Lot: Project: BHATTACHARYYA Project Description: 1,024 sq ft non - habitable horticultural addition. ADDED (2) hose bibbs 6/30/09. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 512 sf Basement: sf Left: Parking Spaces: Height: 21 Bathrooms: 2 Second: 512 sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: Yes Total: sf Value: $40,134.08 Rear: PLUMBING Sinks: Water Closets: 2 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 3 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 2 Garbage Disp: Water Heaters: Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: Heat Pump. N Hoods: Other Units: Fum <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add9 Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) KEYA BHATTACHARYYA OWNER 9608 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $1,071.31 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: 2,g Q Or ( n o\ P ,p CITY OF TIGARD MASTER PERMIT 111 -1 n . - COMMUNITY DEVELOPMENT Permit #: MST2009 -00080 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/27/2009 Parcel: 2S102CD02605 Jurisdiction: TIG Site address: 9608 SW HILLVIEW CT Subdivision: Lot: Project: BHATTACHARYYA Project Description: 1,024 sq ft non - habitable horticultural addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 512 sf Basement. sf Left: Parking Spaces: Height: 21 Bathrooms: 2 Second: 512 sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: Yes Total: sf Value: $0.00 Rear: PLUMBING Sinks: Water Closets: 2 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 3 Dishwashers: Floor Drains: Sewer Lines: SF Rain Drains: Other Fixtures: Tubs /Showers: 2 Garbage Disp: Water Heaters: Water Lines: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: Vent Fans: 2 Clothes Dryers: Heat Pump: Hoods: Other Units: Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'l Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: HVAC: Security Alarm: Vaccuum System: Garage Opener: All Other: Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) KEYA BHATTACHARYYA OWNER 9608 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $1,071.31 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -004 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 9 or 1.800.332.2344. Issued By: d Permittee Signature: J Nara _ Building Division One & Two- Family Dwelling TIGARD Fees Checklist P .ERMIT INFORMATIOISI:.. ° . - Permit #: c 1 2 cog • C ®G 8C Plan #: Date: Site Address: . Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: Setbacks: Front: Rear: Left: Right: Class of Work: Stories: First Floor:, Type of Use: Height: Second Floor: Construction: Floor Load: Third Floor: Occupancy Group: Dwelling Units: Bonus Room: 3 Valuation: tog, mt,,, go Bedrooms: Total Floors: IC Z4 C \A 0 i 134 �© Bathrooms: Basement: '1? Decks: Garage: Porches: Other: FEES:. .Description: . ,. -. .. Fee Amount Paid:' ` Balance`Due;: ; . Plan Check: Building: '. S 8 .(6 )C g S. '47 79 . Extra Set: Permit: Building: Ra? , o9 LP-13 . 59 3 "k d .- p3 Q Tax: 1 c c .C-7 53.2?, (. Ri4 Metro CET: 1 2 rD S School CET: S 1 d 7_4.00 Mechanical Tax: Plumbing: Tax: Electrical: Tax: 1 Low Voltage: . 1 Tax: • CDC: CDC Ping. Rev.: W MI I . • n W P ' i I CDC LRP Fee: ; SDC: Parks: TIF Res.: WA �� I i � TIF MT: Erosion Permit: _ Erosion CWS: ' I , 11 • •l Erosion COT: IF V 4wripir ' Water Quality: . V , _ �i n (, Water Quantity: V SUB - TOTAL: 1 LS 6 (0 2 C3 i_ oft______) Sewer: Permit: Inspection: SUB-TOTAL: : TOTAL MST & SWR: I:A Building \ Forms \ResPlanCheckFces doc 01/19/07 Page 1 ; s " Building Division One & Two - Family Dwelling TIGARD Fees Checklist ':PERMIT INFORMATION' - Permit #: ryA 2 CjCpq • ® ©C) SO Plan #: Date: Site Address: Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: Setbacks: Front: Rear: Left: Right: Class of Work: Stories: First Floor:, Type of Use: Height: Second Floor: Construction: Floor Load: Third Floor: Occupancy Group: Dwelling Units: Bonus Room: K\ Valuation: t(J 9( $o Bedrooms: Total Floors: 1 Q 2 ® ,� �� `�� . �� Bathrooms: Basement: Decks: Garage: Porches: Other: FEES: .Description: :.. 'FeeAmount : . ` "A mount Paid::,.' .Balance. D ue: Plan Check: Building: 88 . .�.. QO 9 . q7 79 .S Co Extra Set: Permit: Building: 0. . O• • LJy J • CDC) • �°� `3 0 - 3 0 so Tax: • 2 3 (0. S4 Metro CET: ' 1 5 Q S School CET: i d 24 00 Mechanical IRWIN. I , . Tax: Plumbing: Mk a 0 It . t N7Ck._ C Q Tax: • Electrical: III A ; W ` at Tax: Nir Low Voltage: _ `_ . 1 A Ll.L1-0.1aua_%Q ' Tax: CDC: CDC Ping. Rev.: / A wan o P wn12 f I Q r ) CDC LRP Fee: SDC: Parks: _ w 0 1I■., L , G TIF Res.: �I . TIF MT: — V''' Erosion Permit: ' Erosion CWS: Erosion COT: Water Quality: Water Quantity: SUB ►OTAL: l LO (p ( • 2 Sewer: Permit: Inspection: SUB-TOTAL: : TOTAL MST & SWR: I \Building \Forms \RcsPlanCheckFces doc 01/19/07 Page 1 . f CITY OF TIGARD FEE AND PAYMENT HISTORY r , g . 13125 SW Hall Blvd., Tigard OR 97223 ,' 503.639.4171 T1GARD MST2009 -00080 - 9608 SW HILLVIEW CT Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due [PLUMB] PLM Permit 245 - 0000 - 431000 $116.20 $116.20 $116.20 3/27/09 Check 172997 $0.00 [TAX] PLM 12% State Surcharge 100 - 0000 - 207020 $13.94 $13.94 $13.94 3/27/09 Check 172997 $0.00 [ELPRMT] ELC Permit 220 - 0000 - 431510 $66.80 $66.80 $66.80 3/27/09 Check 172997 $0.00 [TAX] ELC 12% State Surcharge 100- 0000 - 207020 $8.02 $8.02 $8.02 3/27/09 Check 172997 $0.00 [MECH] MEC Permit 245 - 0000 - 431010 $72.50 $72.50 $72.50 3/27/09 Check 172997 $0.00 [TAX] MEC 12% State Surcharge 100 - 0000 - 207020 $8.70 $8.70 $8.70 3/27/09 Check 172997 $0.00 Building Permit 245 - 0000 - 432000 $443.59 $443.59 $443.59 3/27/09 Check 172997 $0.00 Plan Review 245- 0000 - 433000 $288.33 $288.33 $288.33 3/27/09 Check 172997 $0.00 Build 12% State Surchrge 100 - 0000 - 207020 $53.23 $53.23 $53.23 3/27/09 Check 172997 $0.00 Services or Feeders - 200 amps or less 2200000 -43103 $80.30 $80.30 $80.30 8/19/09 Check 174923 $0.00 Branch Circuits w /Purchase Service or 2200000 -43103 $73.15 $73.15 $73.15 8/19/09 Check 174923 $0.00 Feeder 12% State Surcharge - Electrical 1003100 -24001 $18.41 $18.41 $18.41 8/19/09 Check 174923 $0.00 (manual) Metro Const. Excise Tax - Residential 2300000 -24011 $125.28 $125.28 $125.28 Use Tig -Tual School CET - Residential 2300000 -24102 $1,024.00 $1,024.00 $1,024.00 Additional Permit 2300000 -43104 $390.30 $390.30 $390.30 Additional Plan Review 2300000 -43106 $79.86 $79.86 $79.86 12% State Surcharge - Plumbing 1003100 -24001 $46.84 $46.84 $46.84 (manual) Totals for Fees $2,909.45 $2,909.45 $1,243.17 $1,666.28 t Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due! Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount 172997 Check 1473 KEYA 03/27/2009 $1,071.31 BHATTACHARYYA 174923 Check 1524 Saraswati - Lakshimi -Sar 08/19/2009 $171.86 ada Total Payments: $1,243.17 Balance Due: $1,666.28 Plumbing Permit Application RECEIVED 1' -Y' 4.11 6 Lam 5 • Q o Building Fixtures FOR OFFICE USE ONLY . City of Ti and MAY 2 7 2009 Received , I� /� . g Date/Sy: Permit No.:, 51 !/(i(/( e q 13125 SW Hall Blvd., Tigard, OR 97223f�a!� Plan Review ,51::) Phone: 503.639.4171 Fax: 503.593.196F)< OF TIGARD Date /By. Other Permit No.. TIGARD Inspection Line: 503 639.4175 BUILDING DIVISION Date Ready /By 5' See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE E] New construction El Demolition For special information use checklist Description Qty. Ea. Total Addition Iteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath I 249.20 I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft ) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: q1, 4l \\ v ' \.� O • Catch basin or area drain 16.60 City /State /ZIP: { `n Dr■well, leach line, or trench drain 16.60 sy, Suite/bldg. /apt. no.: Project name: `,� Ch Q 1 , , Footing drain (no. linear ft.: _) Page 2 t ` (Ty". 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: Lot no.: Water service (no. linear ft • ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve • 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 ¶l.30 e )f (J� `F , 1C G (an lr ldn - Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ' PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: 6 ?ft rta1 q. C' r ta leek, Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 'tit APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: ik Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /Z1P: Roof drain (commercial) 16.60 Phone: Sink/basi avator)� 3 16.60 ( ) Fax: ( ) Tub /shower /shower pan a 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet O t 16.60 Business name: H l l�E H/ Li t / i i„, u, a Water heater 16.60 Address:'33p 1Ai r A /:-. 1 �e.-v �� - Other: ^ Subtotal 1 �' 2 O City /State /ZIP: lO Lt i FO N l D 4.-• Minimum permit fee: $72.50 ` Phone: (56;) 7 5 3 to Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: , I Z$ y/� / Plumbing Lic. no.: � / Vi / Plan review (25% of permit fee) C / / State surcharge of permit fee) 13.q4 r Authorized signature: . TOTAL PERMIT FEE lS:) . 14 Print name: liot ( M y ' Date: 57E.VO'f This permit application expires if a permit is not obtained within J 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i \Budding\Permits \PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 55 00 0 to 2,000 $115 00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Stone & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46 40 $5,001.00 to $10,000 00 $72 50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100 00 or fraction thereof, to and including $10,000 00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000 00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27 55 and including $25,000.00. Rain Drain, single family dwelling 65 25 $25,001.00 to $50,000 00 $379 50 for the first $25,000 00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including first 0.00. Subtotal: $50,001.00 and up $742.00 for the e first $50,000 00 and $1 20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower • ❑ Medical gas and vacuum systems for health care facilities. • - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial -Domestic Isometric or Riser Diagram Drinking Fountain Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" - 4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains • Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall • Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: \ i3wtdmg \Permns\PLM- PermilApp.doc 12/27/06 8__ 1 Q. i (l'i C-Z—Itw , Electrical Permit Application rOR ()tro l st om., CI ` Of Tigard Date13y; Permit No.; 8(.20°9 • Q i • 13125 5 �", � S,''' Hall Blvd., Tigard, OR 97223 Plan n Review d Phone: 503.639.4171 Fax: 503.598.1960 Date/13y: Other Permit: Inspection nine! 503.639.4175 flare Read /B : hint 11tia Y Y ®See Paget for Internet: wwwt(igard- oi.gov Notified/Method Supplemental Information .i: .ills ,,,,,,,,,,, , , „y� . :: ^ ia : ' ill :ac . ...... ..::: . �� : : �. a ..•..., .,.. .. - ] .. r ... - �........... �......• 1.•,y. {;� ?q� dip :7.,1:1,7R7riEyy��R11 ..i, �, . r....�. u - .. ._ „ • ... .. .............. .. . •e,:: :.. r_.. i. r � : :- ... 1r. } :; ,. .. •... .� ....... - }^!5?i...�` ;; P: ^, : �a :: , ❑ New construction Addition /aileration/replacement Please check all that apply (submit 2 sets of plans w /helm checked below): ❑ Service or fustian 400 amps or more ❑ Build over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards, • I :;;r.;p{;ihr {: r� :ii iy,t,y......._..,;, exceeds !11 amps at Io0 volts o ❑Floating buildings P. ..,.... f.. : : : aifiii'(ii'f iiiii''' ''':.,,. .. ..... e:.. ^, :a...ya.r.,.a.., ...i. ,; ess 1 exceeds 1400 C o 1- and 2 - family dwelling C ommercial /industrial l o g o�no t or e ns , B Q • ldin g s l -use a 1- g ❑ ❑Accessory building amps for all other installations. buildings ❑ Multi - family ❑ Master builder ❑ Other: Q hre pump ❑ Installation of 75 KVA or • .3 .. e r•• ^ •r•• r = • � • 1 t1, .... • .n ,••,•,o• a '� -, sr ••. Emergency system larger . ate! d s '1•• ^' 1r0 td , i s uet :i :iu• „ system. t11.:: ...., . ,..`... �....,, ..1: -'r n r� .. i ` i .,._:1 : 1Si• .• ... ...r. _... ly.:r ._..... 1 .....- .. : 'g,� ^-" ::: . .� wt ❑ Addiuon °r am motor load of separately Job no.: Job site address: 9C 0 ' SUl/ I 1 QV!/ G t0011P uterus occupancy. ❑ Sex of more residemial emits, 0 Recreational vehicle parks. 7: City/State /ZIP: J a k © �7 ❑ Health -care facilities. 0 Supply voltage for more than /i• r4 0 Hazardous locations. 600 volts nominal. • g p Service or feeder 600 amps or more. i Suite/hid Ja t , no.: Project name: m - „ -..... s :: c xr �ifit} ''. ilt . l i := : : : :r.F. T : ::. : : : :: tii;. Cross street/directions to job site: IlneryNioa ) Qty. I her. } Total I - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. R. or less 145.15 4 Ea. add') 500 sq. R. or portion 33.40 1 Tax map /parcel no.: - _... :.- ...,.: ... • ,:, .... ..,• ...... .. residential 75.00 2 r �E:3 :��i : : n :.. . .. Limited energy, .....:. „ :: ., f., : , .,, .. : :,� : :•_ : :..... •' ,r °:::r » :.' ,.,.r1 iiF; r ? . 4 ' with above .. ,..,tt i n:1:: I • •rT3li{ y;; ^:e: .. ' ..... � . ..,,., i ;... r..• � :i_ :; : : : : : : : :.... : .. .,,.,._. ( 89.0.) Limited energy, multi - family C I n (^ I 75.00' 2 t�f �l�f or (�dv �l�i. i�'r"• residential (with above sq, ft.) lY Services or feeders Installation, alteration. and/or relocation 200amps or less 80.30 2 iii :a :.. ,. ::: : ,.,, ,,',,, �:`� : ... ..... {iaif(: t ray. !' i E11lLiElF # ° 3 ;y i = rs;i'i 201 amp - v : i-a - � �. � :::,... ... s 10 400 amps 106 85 2 Name: 401 amps l0 600 amps 160.60 2 601 amps to 1.000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 own which is not 20) amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new. attention, or extension, per panel Owner signature: A. Fee for branch circuits with 8n Date: t:3r::: :,:•a . •hi. . r - .... . ...... :� : : : :. .. . ..........., ...• ... .. ;:: . : :..... :.....,...... .:: � ..:::.... above service or feeder fee : ,•: .f.. ...i. ;t 6.65 each branch circuit - Business name: B. Fee for branch circuits without service or feeder fcc, 46.85 2 Contact name: first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/Z1P: Each manufactured or modular 9090 2 ,. dwelling, service; and/or feeder Phone: ( ) _ I Fax- • ( ) Reconnect only 66.85 2 E -mail: f • :� : :r..;rs : : :41i1 .......... ....:...::.;:::., ^:::ytrs . ' y � '' " irii r i ie : iiii;i a{ , 'mp0 ITrtgan0 circle t n k 53 40 2 ...,. .... .•..:._.... • ............... u itd.:,:;( IdL:: t :n;,.... :jis' :ii•ii2�..;: Sign or oullinc lighting 53.40 2 Business name: o I, p E 1-e_ C."11 c .171-7 e • _ energy panelt o Address: 2g�vo c -1 AVM # /� extension. Describe: page2 2 City/State /ZIP: �/ ah cos , y , _ w4 9 g 6` ' / ~' . Each additional inspection over allowable in any of the above Per inspection 62.50 I Phone: 002) 57 g - z5 g 9 Fax; (Q) 32 C "96'60- Investigation per hour (1 hr min) 62.50 CCB Lie.: 1725491 Electrical Lic.: 2 3 0 C. Suprv. ic.: Industrial plant per hour 73.75 ,...if 1J .,.. i .. ...v llN : 3 : : :t1 S• ;b :{ +i ...'1'1;1;1: { : ;;;;;;;C:'.::.1'2.::!, Suprv. Electrician signature, required: Subtotal: / V flan review (25% of permit fee): Print name: iii t: S t r ') l>rwx,,cgl Date: ©q(2 /09 State surcharge (12% of permit fee): Authorized signature: SC R G OE j Co en ,4 Q 47,-k L; TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: 07/2 0/e), days after it has been accepted as complete. Uiuildirti ,PamiUtEI.C- nc :milApv.d<x 05 :2a • Number of inspections allowed per permit. . : CO • 440- 4615T((I/051COM/WEB • • U Building Permit Application Residential FOR OFFICE USE ONLY Cl }�r Of Tig RE CEIVED Received (q, D/1� t /��/t ,Q_ i rye GO "✓ Dateiv 7 Permit No.: /'1 Q€YJ ( [X) Q 13125 SW Hall Blvd., Tigard, OR 9 Plan Review � • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: i ' ither Permit: } Inspection Line: 503.639.4175 9 2009 Date Ready/B' luris H See Page 2 for TIGARD ZQ �9 Supplemental Information /� Internet: www.tigard- or.gov Notified/Method3 4 OF TIGARD► `�� ,Za �,e .- v,�n -c�.i 1 -}-o �� e� l�I•IP �1��e. TYPE OF G DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING Permit fees* are based on the value of the work performed. Dyew consction flDemolition Indicate the value (rounded to the nearest dollar) of all Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. (� 1-and 2- family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: L. ❑ Master builder ❑ Other: Number of bathrooms: 2/ JOB SITE. INFORMATION AND LOCATION Total number of floors: Job site address: b Q S .S3 c1�T l' i , C� , New dwelling area: 1 2 j square feet City /State /ZIP: J ( �,� 71 P q��� Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the —/ I/ DESCRIPTION OF WORK work indicated on this application. ` A 1 1 ' I 4 s . - • L) v/ E( Valuation: $ Existing building area: square feet New building area: square feet V4ROPERTY OWNER ❑ TENANT Number of stories: Name: /</E y f f3 A ,( j y1 Type of construction: Address: '' 6 O Q .fj � I v I I V I C4) C 1 Occupancy groups: City/State/ZIP: ¶ j (4�� ) 9c1_-Z Existing: Phone: (S'p3) s! 726 Fax: ( ) New: APPLICANT CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: ,K \J tT LJ LL A A N A Y q licensed with the Oregon Construction Contractors Board / �1 r l 1 r ' // under ORS 701 and may be required to be licensed in the Address: h Q D .� C) ��� `) V I C (—. jurisdiction in which work is being performed. If the City /State /ZIP: y' , v ( 9_ .22 L. alt X03. o(o cant is exempt from licensing, the following reasons apply: O C7 S Phone: ( S�) 6 3 Lt . ZQ 6 Fax:: ( ) E -mail: Ke J C4 • b ha N aeJ -Irk '?j'- () Ve T; )..4/- CONTRACTOR Business name: JJ�J �/� BUILDING PERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB lie.: Total fees due upon application: Authorized signature: �C( Amount received: This permit application expires if a permit is not obtained Print name: � 14 I4i T3 Date: 2l qjd 9 * ee methodology hod lo gy Se af ter t has been a Building gas complete. Y / Fee methodolo set b Tri -County Buildin Industry Service Board. 1: \Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(I 1 /02 /COM /WEB) . I Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY a; Received v a City of Tigard Date /By: Permit No.: II V 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: < Phone: 503.639.4171 Fax: 503.598.1960 TIGARD 24- Hour Inspection Line: 503.639.4175 Electrical ❑ Plumbing 0 Mechanical Internet: www.tigard- or.gov ❑ Other: I THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW I Yes I No I N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . LI ❑ ❑ 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 sitsand surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- . ❑ ❑ ❑ ' floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ . Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and /or any beam /joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS - I . 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\Building \ Permits \BUP -RES- PermitApp doc 03/21/06 440- 46t3T(11/02 /COM/WEB) Mech Permit A li CEIVED FOR OFFICE USE ONLY City of Tigard Received 2 Date/By: / /7 0/ Pennit No.: G J ��go ° 13125 SW Hall Blvd., Tigard, OR 9722JAN 2 6 2009 Plan Review M : ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: T I G A RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: See Page 2 for H Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: f7 ( Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* IKI- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder 0 Other: Description Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: , Air conditioning or heat pump CV a �'Sc,� A)1 V ; e4J 6h (requires site plan showing placement) 14.00 City /State /ZIP: TO Ord 0 k VA.23 Fumace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt.no.: Project name: 9608SCJJ4I CIAIrtijit.9' Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 O L ��� R n t hot water system 14.00 Residential enti al boiler r (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 _ /)ckti i zDer.,/od ixs Lilac, a-({ Ja1 j l /(cdTh Flue vent for water heater or gas Nail RdO }r1 fireplace 10.00 U Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 OZ'ROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00 Other: 10.00 Name: "t\ E v A - R� /4T77 A e y 44 Environmental exhaust and ventilation / Range hood/other kitchen Address: 0'1 OA Jo /, 11 v, ew 0/-• equipment 10.00 City /State /ZIP: � j y 6 g_ 9' -..9 a 3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( 93) pq — 72.d-6 Fax: ( toilet compartments, utility rooms) 9. 6.80 apt APPLICANT ihl CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: KC v A Bij 14 et y y/4 $5.40 for first four; $1.00 for each additional Address: q 6 Q 8 ,wd.ii II ✓i (k) ct. Furnace, etc Gas heat pump City /State /ZIP: -n 04.- 0 a 11- 3 Wall /suspended/unit heater Phone: (SG3 ) i 3 qr 7- 266 Fax: : ( ) Water heater Fireplace E - mail: ya..., b halizzah47,y,Y Ct.® Yeti ion. /led Range CONTRACTOR Barbecue Business name: Ot.)._ Q t Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: K• Watleiteta, y r �, This permit application expires if a permit is not obtained within 180 VV days after it has been accepted as complete. Print name: KF 'I /4 gii A TrAcH /4 f y y,4 Date: * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (1 l /02/COM/WEB) Apt Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or • fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2 PIu 'erm A licatio p �E CEIVE Building Fixtures FOR OFFICE USE ONLY '. ce Cl of Tigard JAN 2 6 2009 Received p ennitNo.: q 131 SW 13125 Blvd., Tigard, OR 97223 Date /By: f9 of Jyyr F D Plan Review Phone: 503.639.4171 Fax: 503.598 OF TIGARD Other Permit No.: Date By: T I G A RD Inspection Line: 503.639 BUILDING DIVISION Date Ready /By: ss: 65 See Page 2 for Internet: www.tigard or.gov Notified/Method: -( kJ, Supplemental Informa TYPE OF WORK. FEE* SCHEDULE ❑ ew construction El Demolition For special information use checklist Description Qty. Ea. Total Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 di- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE. INFORMATION AND LOCATION Site utilities Job site address: DI 6 Of) SO c p-,/'vj eW (.i-. Catch basin or area drain 16.60 City/State /ZIP: ) i y ayt e R 91223 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: q 66 SCJJ -Il j / $i/4.4) C!-. 4idiabt,,..' Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: 0 nialet, 4, Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _ ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 //�� � - DESCRIPTION OFWORK Backflow preventer Page 2 /TcicL "� h t-A ed�a MS, 02 kit .-t la, / 1 y - Backwater valve 16.60 V141 ?(T U 21107, Clothes washer 16.60 Dishwasher 16.60 PROPERTY 'OWNER ❑ T ENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: Key A. aH .-7TACyAlyyg Expansion tank 16.60 Address: 9 6 a g fo i/T; 11 V ; et J C`-, Fixture /sewer cap 16.60 City /State /ZIP: 1 9 0t r d Q (2_ „.22.3 Floor drain /floor sink/hub 16.60 Phone: (S'p3 )) 2 el- 7-JO 6 Fax: ( ) Garbage disposal 16.60 lY1 APPLICANT _ .( /CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: KE 0 )3.p 47 - TAC14 ggyy, Medical gas (value: $ ) Page 2 Address: g6 frJJ //r - et) (/. Primer 16.60 City /State /ZIP: / ;,( a y d Q 4 91-,v3 Roof drain (commercial) 16.60 Sink/basin/lavatory 5 _. 16.60 Phone: ( 93 ) 6 :72,66 Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Key4o bha1 /,a -ryyQ0 ✓eri &b. h.e Urinal 16.60 . CONTRACTOR . Water closet 2 16.60 Business name: D 1, e 2 Water heater 16.60 Address: Other: / 16:2...0 Subtotal ' a City /State /ZIP: Minimum permit fee: $72.50 .' • Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 �94-- I CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: K yCi TOTAL PERMIT FEE Print name: 'Kt y A /H ,9 A Ct 1 A eyy4- Date: //2_6/09 This permit application expires if a permit is not obtaibed within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. l:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) I V) s /°‘' Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty: Fee (ea) Total;° Foota a Permit;FCe: ' S>tteUtilities . _ < Squar g Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: ,; Permit Fee::. Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72 50 for the first $5,000.00 and $1.52 for each Qty.i Fee (ea) Total ' additional $100.00 or fraction thereof, to and ' .. - - including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1 54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work:r P lan , Review for:Plumbing,I Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and " Quanti by (Fixture) Work Performed. greater; except systems designed and stamped. by licensed � - e � . engineer. Fixture_Type: ', � � - , Replace. . Previous Capped ' Added E istik ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain .. .Isometric :or..Riser Diagram . . Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) _ Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory • - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes - Water Extractor Water Closet - Toilet Urinal Other Fixtures: i \Building\Permits\PLM- PermitApp doc 12/27/06 ' ElectriG,,rmit Application 9 , ' CEWED FOR OFFICE USE ONLY City of Tigard Date/By: /9 Dg Pencil No.: )Ira.'? ) �� kr ° 13125 SW Hall Blvd., Tigard, OR 97223 JAN 2 6 2009 Plan Review ',...•.: . Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/By: TIGARD G A R D Ins ection Line: 503.639.4175 Date Re /B 3�ri 1B See Pa e 2 for a, P y� Y y t; r Internet: www.tigard CITY 1 �� � G Notified /Metho f �� Supplemental Information Ali W WILDING DIVISIO •, ' ' E' OF WORK PLAN REVIEW . ' 1 Please check all that apply (submit 2 sets of plans w /items checked below): 1I � 1■ New construct � I A /alteration /replacement 1 ❑ Service or feeder 400 amps or mole ❑ Building over three stories. ,` ❑ Demolition ❑Other: where the available fault current ❑ Marinas and boatyards. � � I CA exceeds 10,000 amps at 150 volts or 0 Floating buildings. 'CATEGORY OF CONSTRUCTION 1 less to ground, or exceeds 14,000 0 Commercial-use agricultural i1 rLl l- 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. \t! , . ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", IOOHP or more. occupancy. Job no.: Job site address: 6 0 o� a `Sco Ali vi e� ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: T jaw/ a 9 7 9.23 ❑ Health -care facilities. . ❑ Supply voltage for more than N • s•� ,, �j ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: di 6 C{�s C) ( ,l47I! Y,Cf.7 Ap({Ge.(�j�� ❑ 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. `` ( ) m a w , Y q� Includes attached garage. \ 16 Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 \ ` Tax map /parcel no.: energy, residential � Limited ener 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) I` 4,_ / Limited energy, multi- family �}G WAY7 -- ° V Z �11400ri`Si a t S A/ y Ra72-1 y residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation p1 19 9---- ZO 77' 200 amps or less 80.30 2 „.' `, - , PROPERTY OWNER u , ❑,.TENANT • 201 amps to 400 amps 106.85 2 • 1 , • ` \ Name: KL y A BO X17 ACI- A tyy-ti 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 , Address: GI 6 0IS) Jell ✓j' to Cfi • Over 1,000 amps or volts 454.65 2 .Cit j 99li yG ( 0 Q- -9�a2 re mporary services or feeders installation, alteration, and/or Phone: ( 503 ) 63q. 7 -L oh Fax: ( ) 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 599 amps 133.75 2 l �f o 9 _ Branch circuits — new, alteration, or extension, per panel Owner signature: wngnature: , ■ . I „ia ,,_ Date: A. Fee for branch circuits with IG APPLICANT' ' I 17 CONTACT PERSON above service or feeder fee, 6.65 2 � each branch circuit Business name: B. Fee for branch circuits Contact name: V without service or feeder fee, f _ 46.85 2 KE y4 BN�)r7A Ci)RleyYi first branch circuit _ 'w i dress: q 6 ow Jed 0I)) ✓", e0 (,- Each add'I branch circuit 'J` 6.65 2 D Miscellaneous (service or feeder not included) City /State /ZIP: % j t.. 9 0 . t1-225 Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ('c3 ) 62..O' Fax: : ( ) Reconnect only 66.85 2 \ k‘; mail: Ke ya ..0 1 chtr, ,Y4- 6 Ye-r' 4Oh , ly."- Pump or irrigation circle 53.40 2 • 'CONTRA Sign or outline lighting 53.40 2 N` Business name: o 'r.) E 2 Signal circuit(s) or limited- ` `l energy panel, alteration, or 1 Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75 - `ELECTRICAL PERMIT FEES - - . Suprv. Electrician signature, required: Subtotal: 0(0, go Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 6, Q Z Authorized signature: .K 64 n Q� TOTAL PERMIT FEE: e s � k. (2j7o Print name: KE y sil�'f'j/ i4. A r y y A Date: 1/2 610 q This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ' Number of inspections allowed per permit. 1:\ Building \Permits\ELC - PermitApp.doc 05/23/06 440 -46t 5T( t 1105 /COM /WEB Electrical Permit Application - City of Tigard . pP tY g Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIALVORK ONLT' . _ Fee for all residential systems combined....... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: rCol101ERGIAL;WORK ONIAT Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n 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: \ Buddmg \Permits\ELC- PermitApp.doc 03/23/06 • Ci , / AO 1 3 2/20/09 / i ! � r A Cl V i � ) / Ke Bhattacharvya j �\;\") � - ' 1 ..< 9608 SW Hillview Ct �� 9 4' -� MST2008 -00148 and MST2009 -00080 ,�� V�' Vt ..., g permit: � � r ' . G Refund on o �,�� original ermit: �!/ No refund on plan review portion of the fees - City has already performed that work by reviewing ♦4 and approving the original plans. 7 2/ �' r Only 75% of the permit portion of the fees can be refunded as we have performed 25% of the 6 ` re nixed ins inspections. (2 out of the 7 required inspections) eies eviem ' / C /cc:''(' - '' `i 9 P ( 9 p )= /Sri �..v ' �� c. /J %s ✓s - (/ - S/`7G'lIc.GS A,2..c26 ct //vsA C'.iic%/..1S &Y .3' /97 2 s '91 i// i- /bc�`7(f - 2K , 444- - Our standard practice is that any monies we refund, be refunded to the original payee. Your general contractor paid both the submittal fee and the fee balance. j /C f * *If you can provide documentation that you have already paid your contractor for these fees, then �� If we can refund the monies to you. You will need to provide us with the contractor's detailed invoice 4) ,7 ; and verification of your payment to him, cancelled check, credit card statement, etc. ', isei/SS'a.6 i /fiS u, :Tff G ilsiZ/c -tE2 . 77 ci. ; 7 : L u "77-7-/E77. cc' /LL // ` 4 e 1,1,./"7 e j 775 Sl/ iLi e' } y /'-r e7- 7? �G1/u i .2 e - ri: Septic tank requirements: At plan submittal your site plan did not indicate location of a septic system. Review of our parcel records indicate your property is on a septic system. Because your addition includes (2) bedrooms, we will need a copy of an approval letter from Washington County Environmental Health Department that states your existing septic system is acceptable for this addition. Without an approval letter we cannot issue this permit. Washington County Environmental Health Department: 503 - 846 -8722 � (r - �C 6 / G _ — %h °i$ / /IFe" /L Cush' / 7Ei�. / T/f C j� , dc7 -- & Connection to sewer service: You have the option to connect to sewer service. You are in Sewer Reimbursement District #28. You would need to pay the sewer reimbursement fee (currently $13,366.40), the sewer connection fee (currently $3,135.00), plus the plumbing fee for the installation of the line work ($81.20 or $113.57). i 2 / , irt O /.f 5 / f'u.c L' i ! .ni , rr 'S f - .0 � � � Ci�.� 7:4! � /5 /2 ECsZ.;.c ; /2,--.7,6 v /- � 27/is ,.16 � � drcJ ,, (.�'. Cic<'T -'/!�2 (62.4'. cs7 ) CC7i y OE /LC?. & s , /F/v.7 Zd ye ,F 1 A}//) // 46 A,'% ,/ /G / �L 70 7 ‘": - ://23 - 7 ---- / /T ... A-ES r" e/5- ,) '/L.S T / E72., � . - - r -'v /� ,77: ./T" Z./ S . E/t/ f T 4 ,.i �jit �1//�? vC �. Li, // Ple ! /`e t! . e S S 7Z / 7,`j, A/ J iL.> ct V( c - /V IZ L;,x /6G 9 -% /v' /' /-s 7V CGAS / 4` G/)/ .</ XT V, S,7 - a te` ,2,t =Z // Cc"..) ei� '44-NS ' 9 ki /7 / nl //r fis// t , //v i e'9 -n;. 7 3 7/ - 4 -C-2'v/`:s 1 -. /� € e c�- /'rte / / Zi. t �� .S�z'u L./I-. (> > , -r�'�5 ,�- , mac- - c �;�,,;; .� /� ,� /s �� 7 c�,iz�:a 1� 7Z___ /'=}- Ci (La s; �/v ,'E= ,vf) ‘,7.,%1,��'-,, e.':re_._ /!C/i. -' .�i /t/e}o U i�: • =77. 2/20/09 Keya Bhattacharyya 9608 SW Hillview Ct MST2008 -00148 and MST2009 -00080 I Refund on original permit: No refund on plan review portion of the fees — City has already performed that work by reviewing and approving the original plans. i 2r0 �' Only 75% of the permit portion of the fees can be refunded as we have performed 25% of the I //+/S g � y required inspections. (2 out of the 7 required inspections)) L'usro/y�2 ,6/S/3u�U - 0 / &) /'cC77°'`!, Sh`0k/E.6 /o2o0G o/c „I. //v5AE�770/J5 oN So - .b9)' by 7-7,6,--/t-m-,2,_ . Our standard practice is that any monies we refund, be refunded to the original payee. Your general contractor paid both the submittal fee and the fee balance. 3 J0 * *If you can provide documentation that you have already paid your contractor for these fees, then W n , pr we can refund the monies to you. You will need to provide us with the contractor's detailed invoice i'll and verification of our payment to him, cancelled check, credit card statement, etc. .2 /SeQSsEJ) TY/ u) /7 G u5'7 1E ,97 Z eOuNrt . / C �aS7a /1 7 u/ /GL / 2)dea `fcA/ 7a £9 <i f' E y/-1Avr /7 G�ON T/ ere , OL(I/Y Septic tank requirements: At plan submittal your site plan did not indicate location of a septic system. Review of our parcel records indicate your property is on a septic system. Because your addition includes (2) bedrooms, we will need a copy of an approval letter from Washington County Environmental Health Department that states your existing septic system is acceptable for this addition. Without an approval letter we cannot issue this permit. Washington County Environmental Health Department: 503- 846 -8722 J z, J ' Gq-vt 7-1//S /AiFe 70 CusTV/� - e. /9-r 77/-e C / "J r ,. - g, 7 Connection to sewer service: You have the option to connect to sewer service. You are in Sewer Reimbursement District #28. You would need to pay the sewer reimbursement fee (currently $13,366.40), the sewer connection fee (currently $3,135.00), plus the plumbing fee for the installation of the line work ($81.20 or $113.57). 0< .2 31°,r-eoNST/L- t e770/✓ ;KC.rS� 7*y /5 g- / 77f%S /TioN , (� e- c asra/7E2 / 6- ei.¢-cES7-E- co, or - g.,.,, , / /„, &•v, ry ,6'" w/y /T 4/e--s /V T (97a/ TrJ f /2S7 %E/L/v/T/ ...z /2- E / 7 --- / /�1 /T �Grzr T"/,`/1-T /7 4// &"5cEnef T /5 /9 'jan/2ooiy kJ // ,9eCESS 7 /- i'9 /A/ 2E5 /.d e7ve - /1/E"E/ E7( /4'I 'Al - 77/ 7Z Cas Tr^1E - /L O/✓ A/ 7 1 , -- J D 9 g-E El") o` , 41-NS W /Tff / -/ /VEZ -5 "t/ //✓A/ e - rs 7-71--7-- 41.----- ,'/A/,E.s ,e S64 U-S 8s c ') ,97✓,v /9- /- -/c- - d e,9 of ,1 /'r�/9/7 rs / L//2-3 , 7Z '7' /"D.vs , /VET Cu s � /?E//'S g76/U/ %-c D 2- i ° /°G / /O/(/ .1-T Arey) 7l /S'2 <*4- _ w Building Division Notice 2/19/2008 TIGARD Important Notice * * * * * * * * * * * * * * * * * * * * ** School District Construction Excise Tax (CET) The City of Tigard has entered into an agreement with the Beaverton and Tigard - Tualatin School Districts to collect a construction excise tax on improvements to certain real property that result in a new structure or additional square footage to an existing structure. The CET will be collected prior to issuing a building permit for applications submitted on or after March 1, 2008. /1ST;:2-ooI- e/Y? S'QM/ 9 a y o0P' t, 5 - 14 aka QM " t� n✓d T �Iu�� /Fy 9-i /-70 r�M In 2007, the Oregon Legislature passed Senate Bill 1036 allowing School Districts to 50/-- impose a construction excise tax (CET) on improvements to certain real property that result in a new structure or additional square footage to an existing structure and may not exceed: (a) $1.00 per square foot on structures or portions of structures intended for residential use, including but not limited to single -unit or multiple -unit housing; and (b) $0.50 per square foot on structures or portions of structures intended for nonresidential use, not including multiple -unit housing of any kind. In addition to the limitations, a construction tax imposed on structures intended for nonresidential use may not exceed $25,000 per building permit or $25,000 per structure, whichever is less. The calculation methods for the CET are on the back of this notice. Please ask the Building Permit Technicians for a copy of this notice. I: \Building \Public Notices \Notice - School CE 1 2- 19- 08.doc t • It is understood that prior to issuing a building permit, the City of Tigard (City) will collect the CET. The School Districts (District) and City agree to the following as the method to be used for determining if the CET is applicable and how it is to be calculated: • Square footage of residential uses shall include single -unit and multiple -unit houses including non - transient boarding houses, adult foster homes, and congregate living facilities; and dormitories (as defined in the State Building Code) shall include the gross floor area of the building or addition measured from the outside of the wall to the outside of the wall and shall include the square footage of unfinished basements or bonus rooms but shall not include the gross floor area of a garage, carport, covered walkway, exterior deck, covered exterior porch, patio cover (screened or open), sunroom (unless the sunroom has openings into the house that are without doors or windows that can be closed), and accessory structures such as garden sheds or shops. • Square footage of residential use shall include the gross floor area of a manufactured dwelling or an addition thereto measured from the outside of the wall to the outside of the wall and include the area of cabanas but shall not include the gross floor area of a garage, carport, covered walkway, exterior deck, covered exterior porch, patio cover (screened or open), sunroom (unless the sunroom has openings into the house that are without doors or windows that can be closed), and accessory structures such as garden sheds or shops and ramadas. Square footage of residential use shall not include a manufactured home that replaces an existing manufactured home located in a manufactured home park. • Square footage of residential use shall include the gross floor area of a moved residential building (unless it is moved to a different location on the same property) measured from the outside of the wall to the outside of the wall and shall include the square footage of unfinished basements or bonus rooms but shall not include the gross floor area of a garage, carport, covered walkway, exterior deck, covered exterior porch, patio cover (screened or open), sunroom (unless the sunroom has openings into the house that are without doors or windows that can be closed), and accessory structures such as garden sheds or shops. • Square footage of hotel, motel, transient boarding houses, convents, college dormitories, fraternity, and sorority uses shall be considered non - residential uses. • Square footage of non - residential uses shall include the gross floor area of the building or addition measured from the outside of the wall to the outside of the wall or where no wall exists shall include the usable area under the horizontal projection of the roof or floor above. • Where an existing residential or non - residential use is removed from a property (in part to in total), a credit towards the CET for the new use shall be applied based on the square footage and use of existing building. No CET credit shall be applied if there is no record of the square footage of the existing use. Unless authorized by the District, credits are non - transferable to other properties. • The CET shall be applicable to building permit applications received on or after the effective date of the Intergovernmental Agreement (IGA) between the District and City for collecting the CET. Should an increase in the CET be authorized, the new rate shall be applicable to all building permit applications received on or after the effective date of the increase. Any building permit application received prior to the effective date of the IGA or increase shall be subject to the CET or increase if the fee has not been paid or the building permit issued within six months of the effective date of the IGA or increase. • The CET shall not apply to structures that do not require a building permit, cell towers, water tanks, retaining walls, swimming pools, private bridges, or covered play structures. • CET fees may be refunded if they are collected in error or the CET is paid for a development that will not be constructed. Requests for refund must be in writing and submitted to the City not more than 12 months from the date the CET was paid. I: \Building \Public Notices \Notice- School CET 2- 19 -08.doc ,. 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. Of • I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. K E/ A SH4T -r lCMr A Print Name of Permit Applicant . age a l 1'i Signature of Permit Applicant Date Permit #: Jr-o9—C 0F _ \. Address: 9 1008 L 1 CT A '" oQ 9-72-a3 f .. ; VW- Issued by: 3; g',71 Dat This Copy for Permit Offices • 1 , 1 q Building Division One & Two - Family Dwelling T 1 G A R D Fees Checklist `.. PERMIT 'INFORMAT,ION::; Permit #: 1A . 201 CrO Plan #: Date: Z . I 9 Site Address: . q6 H((L - V ! �- Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: Setbacks: Front: Rear: Left: Right: Class of Work: Stories: '1/ First Floor:, ( a- ( Type of Use: Height: 2 t Second Floor: Construction: 1 5 1 3 Floor Load: 4 j0 Third Floor: Occupancy Group: Dwelling Units: Bonus Room: Valuation: • ' f �rj ' , 2 Total Floors: (0' Bathrooms: f/ Basement: Decks: • Garage: Porches: Other: : ee Airiq.unt �Ainouiit.Pa � " Plan Check: Building: 3r Extra Set: Permit: Building: N Z. I OA Tax: Metro CET: • School CET: ' O7.A , 00 Mechanical Tax: Plumbing: ESI1 , AO Tax: Electrical: . f .85 Tax: , OZ Low Voltage: Tax: CDC: CDC Ping. Rev.: CDC LRP Fee: SDC: Parks: TIF Res.: TIF MT: Erosion Permit: Erosion CWS: Erosion COT: Water Quality: Water Quantity: • SUB - TOTAL: 2 Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: • I: \Building \Forms \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- family dwellings -.. ..: - . Heating/Cooling . (includes 100 ft. for each utility connection) 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) 17.90 • SFR (3) bath 399.00 Gas heat pump 14.00 • Each additional bath /kitchen 45.00 Duct work 1 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 - 1 100' 55.00 Water heater 10.00 Footing drain - each additional 100' 46.40 Gas fireplace 10.00 Manufactured home utilities 110.00 Flue vent (water heater /gas fireplace) 10.00 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 - 1 100' 55.00 Chimney /liner /flue /vent 10.00 Sanitary sewer - each additional 100' 46.40 Other: 10.00 Storm sewer - 1 100' 55.00 Environmental Exhaust & Ventilation Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment 10.00 - Water service - 1 100' 55.00 Clothes dryer exhaust 10.00 Water service - each additional 100' 46.40 . .Fixture.iir Item . • - •. • Single duct exhaust Absorption valve 16.60 (bathrooms, toilet compartments, Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer • 16.60 Other: 10.00 Fuel Piping Dishwasher 16.60 * *($5.40 for first 4, $1.00 each additional) Drinking fountain 16.60 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 ** Garbage disposal 16.60 • Range ** 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 C)/0 7 5 16.60 Subtotal: $ Tub /shower /shower pan 2- 16.60 Minimum Permit Fee.$72.50 $ Urinal • 16.60 Plan Review Fee (25% of Permit Fee) $ Water closet ?j 16.60 State Surcharge (12% of Permit Fee) $ Water heater 16.60 TOTAL PERMIT FEE $ Other: Other: Plumbin:P,erroit-Fees ° ELECTRICAL FEES (residential single- or multi - family) Subtotal $ r tir`l'AO Description Qty. Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less 145.15 4 Plan Review (25% of Permit Fee) $ Ea. add'! 500 sq. ft. or portion 33.40 ' 1 State Surcharge (12% of Permit Fee) $ U7, 6t3 Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ I (01. '�'2� Each manufactured or modular 2 dwelling, service and /or feeder 90.90 . Electrical Permit Fees ' .- - .- Subtotal: $ Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ TOTAL PERMIT FEE $ I: \Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 2 • 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. BUILDING DIVISION TIGARD TRANSMITTAL LETTER a TO: m !) Q,1&jIrm DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FEB 1 1 2009 FROM: YY\ NaVQ CITY OF TIGARD BUILDING DIVISION COMPANY: PHONE: • B— RE: 9 ( 5Iia O- . • (Site Address) 'ermi ase lumrer (Project name or subdivision name and lot number) • ATTACHED ARE THE FOLLOWING ITEMS: Additional set(s) of plans. X Revisions: (L 2 ) 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: Routed to Permit Technicia Date: °% (5Ql Initials- Fees Due: ❑ Yes io Fee Description: 0 Amount ue: :y; ' 4 'ti a'e'` %n'`f ..�q. "`•: <D • _ "x , .. •ate .."='[_.. , - .`'... . ~- .�"'rti:� n - "" r' Special Instructions: Reprint Permit (per PE): n Yes n No ❑ Done Applicant Notified: Date: • Initials: 1: \Building\ Forms \TransmittalLetter- Revisions .doc 4/4/07 \I 4 • 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. . 'his form and the information it provides helps the review process and response to your project. BUILDING DIVISION TIGARD TTZANSMITTAL LETTER TO: DATE R C IVED: DEPT: BUILDING DIVISION CEI V ED JAN 2 6 2009 CITY OF TIGARD FROM: KEY A 3l4- ATTAG14 BUILDING DIVISION COMPANY: PHONE: 5_0 3 860, 0 1: 02 f 46 Ativa litrn- Q . BY: S02 639. 'Jlr 6 007-e) RE: ( 16 06 40 J - +'i I1 r ; ew C/ . 7 0R912.Z3 I'1 < n4R - OD146 (Site Address) (Permit/Case Number) g 6 DgSGJ,N ;II Y; ect) acid) / 9- ,.240.S W / 61 2009 _ COCEb (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 OFFICE USE ONLY Routed to Permit Technici • Date: Initials: Fees Due: ❑ Yes o Fee Description: Amount Due: • Special • Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: • I:\Building\ Forms\ TransmittalLetter- Revisions.doc 4/4/07 2/20/09 Keya Bhattacharyya 9608 SW Hillview Ct MST2008-00148 and MST2009-00080 Refund on original permit: No refund on plan review portion of the fees —City has already performed that work by reviewing and approving the original plans. Only 75% of the permit portion of the fees can be refunded as we have performed 25% of the required inspections. (2 out of the 7 required inspections) Our standard practice is that any monies we refund, be refunded to the original payee. Your general contractor paid both the submittal fee and the fee balance. **If you can provide documentation that you have already paid your contractor for these fees, then we can refund the monies to you. You will need to provide us with the contractor's detailed invoice and verification of your payment to him, cancelled check, credit card statement, etc. Septic tank requirements: At plan submittal your site plan did not indicate location of a septic system. Review of our parcel records indicate your property is on a septic system. Because your addition includes (2) bedrooms, we will need a copy of an approval letter from Washington County Environmental Health Department that states your existing septic system is acceptable for this addition. Without an approval letter we cannot issue this permit. Washington County Environmental Health Department: 503-846-8722 Connection to sewer service: You have the option to connect to sewer service. You are in Sewer Reimbursement District #28. You would need to pay the sewer reimbursement fee (currently$13,366.40), the sewer connection fee (currently $3,135.00), plus the plumbing fee for the installation of the line work ($81.20 or $113.57). A