The URL can be used to link to this page

Permit .pri ii C t . ‘ • d LJJ c a rR CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009-00163 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/07/2009 Tr' c . rl�a Parcel: 2S102CA00208 Jurisdiction: Tigard Site address: 13255 SW ASH DR Subdivision: VIEWCREST TERRACE Lot: 6 Project: Westfall Project Description: 398 square foot addition to rear of home. 9/1/09 added (1) service and (5) branch circuits to permit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 398 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right. 5 Detectors: Yes Total: sf Value: $40,576.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning. N Vent Fans: 1 Clothes Dryers: 1 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 Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 5 Ea addl 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr. Limited Energy: 401 -600 amp. 0 401 -600 amp: 0 Ea add Br Cir: 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 Ecom asin N Other: N Other Description: p g' BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) WESTFALL, BEN GRIMSON COMPANY INC 13255 SW ASH DR 11432 SW CAPITOL HWY TIGARD, OR 97223 PORTLAND, OR 97219 PHONE: 503- 639 -4049 PHONE: 503 - 620 -3678 FAX: Total Fees: $1,382.18 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 AR 95 001 -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: LAI) Electrical Permit Application RFrpM., FOR OFFIC USE OFFICE IA t ,, � � ., _ 12eceived Permit No: r' • . City of Tigard Date /B : _ 24 • • 01 a 13125 S SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 S E P ®I 2009 DateBv: Other Permit TIGARD Inspection Line: 503.639.4175 p r,e Date ReadyBy: El See Page 2 for Internet: www.tigard- or.gov CITY Y OF T GAF FNotified /Method. ®� Supplemental Information ,• :- ` .), - -1 .;,t..�,7! sTYPE' :O .` .3.,i .:4 _, ; r : = , I' .,.--, ?IE ? , - ,, i : " - t, ": 't�i A., ,..x :? �r� ..r',� �: �`^. ' �# �.-:.. , .x,<�: : }�.= ?:',.i-� : vi:�s�sx .:..Q�;: ",`n >'ir. +. r.4� t� � Yr:u €:.s *�. 3"t` ..��t.. -; .r�a:.,., ,.-�....F:.,v ..,.�,:._ _a �at --... �.... � zt yr ❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): 'Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition Other: ./ where the available fault current ❑ Marinas and boatyards, r 1 ; y , CAT^EG 0101: ONSTRUCTI .11, = a I exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14,000 ❑ Commercial -use agricultural y 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or yt... 7 ; _ >- � - t - :,•: :x t .-, r > 7c,,, s i a,A n v,,.,_ �; w- ❑ Emergency system. larger separately derived system 11 " ;.. J OB S � E O �' r '-" ;: t � ' � r �, k �I RJ�TI(SN„ : sA' ND�,.L ® , C A T =I®N "� -''��alet . y�� 0 Addition of new motor load of ❑'<A "E "1.2 <'t -3 Job no.: Job site address: II C C ,t µ �(� 100HP or more, occupancy. l Z✓ / om �N ! 1 IIP" ❑ Six or more residential units. ❑ Recreational vehicle parks. � City/State /ZIP: �. � CO L ❑ Health -care facilities. ❑ Supply voltage for more than 7 � Z �f ❑ Hazardous locations. 600 volts nominal. Suite /bldg, /apt. no.: Project name: ❑ Service or feeder 600 amps or more. Cross street /directions to job site: >; . .; �-rxa::, OOE; SCHEDULE - i,, - ; * = r J Description 1 Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1 Limited energy, residential .,ma .°.rce_ o.: ...,,, . -,W. _,•,F .,,,m.: t:.e.<,_ 75.00 2 ','" . .: TA DES V o'f 6 ` 1.. IV02e ' 0z$W.- Z ^°`- , • (with above sq. ft.) Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation „ �,= 200 amps or less 1 80.30 2 i s 5 „v :..;;:.-. iy,: c <fi s "4 """ CGS '. i w z. ?^; � q R R .rm'� O ' NER ,, ,,,, "' • 4 . ' E1iTAI g , ;` 201 amps to 400 amps 106.85 2 Name: jam{ C . - . /- 1-3 L 401 amps to 600 amps 160.60 2 VV "V 601 amps to 1,000 amps 240.60 2 Address: D24 5 5 4.-3 A Over 1,000 amps or volts 454.65 2 City/State /ZIP: --i' t 'J .01 -72L,3 Temporary services or feeders installation, alteration, and /or relocation Phone: (.5o) ) 631 _ 4045 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 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with . .•.� - +�t.� _ , � • � ,. c•,s.,,-;:::. .��.cr. > L � - a5>28 �. ., , g am.,., �,a i?'.' n'a� uma uer..rt. amp.. .,. , ...,,;y`�+=L';4 = „:� 2 ,i,,i,;z ` . : A PP C , r, - r R w „ a ,; w CO Ix P ERSO above service or feeder fee, ., -- .a.� ,,,., 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) • Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 ... '. i, ,.. 11,, 4 ItitglVVPV In Si or outline lighting 53.40 2 Business name: f��- 6�ZPc Signal p an e l, al er li or energy panel, alteration, or Address: (12 Sr )(e "T '?L extension. Describe: Page 2 2 City/State /ZIP: O&i fb e_ - 77 2 Each additional inspection over allowable in any of the above ) Phone: (5 14 �ci Per inspection 62.50 S 1 � Fax: ( ) Investigation per hour (I hr min) 62.50 CCB Lie.: l7 (SO Electrical Lie.: 02 Suprv. Lie.: 45 q 5 Industrial plant per hour 73.75 E � 1 10 • 1 . 1� I 1 O • t . t d f , wE E(":CR_ TGAI, P RMT �F�E S�°� 7. ' Supt v. Electrician signature, required: Subtotal: ., / / / Plan review (25% of permit fee): Print name: J D�1 S /� Gpf fZ- Date: %' /coq State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: ID 7. I g This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. ` Number of inspections allowed per permit. t.\ Building \Permiss\ELC- PermitApp.doc 05/23/06 440-46 15T( I l /05 /COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: v RESI ISNIEIAL W IQ K ONMVVAS „ . ,, A Fee for all residential systems combined .. $75.00 Check Type of Work Involved: f Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* [1 Other: 70O1VIl itarAIitUa ONLY„ Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: I I Audio and Stereo Systems I Boiler Controls ❑ Clock Systems fI Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC E Instrumentation n 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\ Buildin \Permits\ELC- PermitApp.doc 03/23/06 .'.d :, CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009 -00163 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/07/2009 T . .; ., Parcel: 2S102CA00208 Jurisdiction: Tigard Site address: 13255 SW ASH DR Subdivision: VIEWCREST TERRACE Lot: 6 Project: Westfall Project Description: 398 square foot addition to rear of home. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 398 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $40,576.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins 0 Lavatories: 0 Dishwashers: 0 Floor Drains. 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 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 20 1 -400 amp: 0 201 -400 amp' 0 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea adds Br Cir: 601 -1000 amp: 0 601 +amp -1000v 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description. Ecompasing N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) WESTFALL, BEN GRIMSON COMPANY INC 13255 SW ASH DR 11432 SW CAPITOL HWY TIGARD, OR 97223 PORTLAND, OR 97219 PHONE: 503 - 639 -4049 PHONE: 503 - 620 -3678 FAX: Total Fees: $1,255.00 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 issu. n -, 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 AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. r :.6699 or 1.800.332.2344. - �o I n 1 0 �( /� '� ' Issued By: C/ "A .0 t N �" Permittee Signature: .J - i • I rw ' Aug 1'2 09 08:08a 5035743252 p.2 , Plumbing Permit Application Building Fixtures �CEIV D FOR OFFICE USE ONLY City of Tigard Recei 111 11 - g Date/By: Perish ?t.,4 No.. ?t.,4 200 ] _ OO / 3 q (3125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.196It l j i 1 0 09 p Other Permit No.: Inspection Line: 503.639.4175 71GA1:D T t�� Date Ready /D H y. hair: See Page 2 for Internet: www.tigard- or.gov C � � ,r��i`r , s/ 1 16,, R 1) r ^ * Nolitied/Me■hod: Supplemental Inform: Aka TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ For special information use checklist Description I Qty. I Fa. I Total ® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 Gil 1- 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 .IOB SITE INFORMATION AND LOCATION Site utilities Job site address: j 3 ,.,s SL;) As, Dr. Catch basin or area drain 16.60 City /State /Z1P: - A . "' - _ Drywell, leach line, or trench drain - 16.60 Suite/bldg. /apt. no.: Project name: t es tic J Footing drain (no. linear ft.: ) Page 2 Cross street/directions to 'of) site• Manufactured home utilities 1 10.00 --.... Manholes 16.60 Rain drain connector 16.60 ((1) 6 H 'T.94 - 00 ( to 5 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft,: ) Page 2 Tax map/parcel no.: Fixture or item Absorption valve 16,60 j . DESCRIPTION OF WORK Backflow preventer Page 2 //} ✓ kri'1 hi/ r^p ( l eli � , Backwater valve . 16.60 J Clothes washer f 16.60 /( .6 Dishwasher 16.60 ❑ PROPERTY OWNER i ❑ TENANT Drinking fountain 16,60 l Ejectorslsump 16.60 • Name: Expansion tank 16.60 Address: Fixture /sewer cap 1 6.60 City /Stale /ZIP: l Floor drain /foorsink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 11 APPLICANT ❑ CONTACT PERSON Hose bib f 6.60 I J_ - Ice maker 16.60 Business name: S 1u� O W' i � U11 I n (W I lrJ1RLi s �YlC . Interceptor /grease trap 16.60 C•1 / Contact name: - R 1 &n it } J Medical gas (value: $ _) Page 2 Address: I - i 3 Su; py,l1 hZC_ Ci , Primer 16.60 City/State./ZIP: P: Roof drain (commercial) 1 6.60 3eoal eo ter, ,„2., 9 z c�u 7 - Phone: (iSb3) �( Jr) _y57y Fax: : (i9D3) S-1 Sink/basin / lavatory ) 16.60 /(p Ca,� - Tub /shower /shower pan c 2 , 16.60 33 -30 E- mail: 5; Ivey co111n _ 1 ►` M Vb;( - '.3 ` rn Corn n, Urinal 16.60 CONIi t Water closet 16.60 / (a , (a p Business name: Cj; I V /`�/1fXU1tli‘n P . + ? 1iJ & i_ i � � r Water heater 16.60 Address f (r� 3 &t , ,,), Ili Other: Subtotal td 3, pp City /State /ZIP: 6a.v .6„ og c1 Minimum permit fee: $72.50 Phone: (S 6,,(.. Li -, e31 3 ' < Fax: (5 ?) 5 _ 7L/ .3 DS e3- • Residential backtlow minimum permit fee: $36.25 CCB Lic.: 15 I,.7 4 i p'2- 01 Plumbing Lie. no.: 3L.{ , Li a � P3 Plan review (25% of permit fee) 0 �' State surcharge (f 2% of permit fee) C7 4 la Authorized signature: / - _ . __ _�� Lt),Utc �f TOTAL PERMIT FEE_ 9aa9(o Print name: De; h l \ ( Date: D' V f This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. *Fee methodology set by'I n - County Building Industry Service Board. Branding ilding Permit Application Residential FOR OFFICE U SE ON y' City of Tigard 0 '09 /B d 7 Q Date DQ P No: �� - /6 3 ° 13125 SW Hall Blvd., Tigard, "e�<<' Plan Review AA � r ' • Phone: 503.639.4171 Fax: 03.598.19% a '1 DateBy: I ""` ' ..7.... 0 Other Permit: TI G t1 RD Inspection Line: 503.639.4175 � t V� J Date Ready /By: ��r /� ® pple See Page mental 2 for Information _ Internet: www.tigard- or.gov U O Notified/Method: �% Surm IN XS° - - - • , -- , • TYPE v . �1( U ° M REQU W II2ED_DATA: 1- AND 2 -FAMY DWELLING El New construction ['Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead nd the profit for the CATEGORY OF CONSTRUCTION - work indicated on this application. �'� Valuation: $ -1/ / ` 616 El pC1- and 2- family dwelling Commercial /industrial t� 111 Accessory building 111 Multi-family Number of m : 170.4j 0/0a_ ❑ Master builder ['Other: Number of bathrooms: PTO ��(t JOB SITE INFORMATION AND LOCATION Total number of floors: O /0 &., Job site address: I 3 a 5 5 . . (.,(' New 17:). R , New dwelling area: square feet 316 • City /State /ZIP: - ", �3' � D I ( 0 « r 1 722 ' Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: ( �j f i- L. L Ado Covered porch area: square feet Cross strect/directions to job site: 6 S -( ST , Deck area: square feet Other structure area: square feet C REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. t "� ,t-r-S A5 R ,, i v , ^ \ `b I <o Valuation: $ Existing building area: square feet New building area: square feet . )°` PROPERTY OWNER ❑ TENANT Number of stories: Name: / P - 0\-J (M6-- r rA LL Type of construction: Address: 132-S5 .S (Ai ,4 'il j), t Occupancy groups: City/State/ZIP: / 619 r)",--, . q `r z.2e--/- Existing: Phone: (1 3) — 905/9 Fax: ( ) New: ❑ =APPLICANT V CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: T ( l 67 f1.D licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: ((.4-32 6 ua e Ptio f T U L N t" J t jurisdiction in which work is being performed. If the City /State /ZIP: P 8- -1 fit/L2 6 ,!L " apply: a applicant is exempt from licensing, the following reasons Phone: (1,3) e41 ._2_ ( Z 3 Fax: : ( ) E -mail: • CONTRACTOR —r Business name: ate- S ,) „, O . _ BUILDING PERMIT FEES* Address: ( (4'*2— c.v . • ✓ -L R— L.L. -7 (Please refer to fee schedule) . Structural plan review fee (or deposit): City/State/ZIP: t " P 'l Fax: ( ) FLS plan review fee (if applicable): hone: ( ` ��. -3." q� Total fees due upon application: O,oe'• CCB lie.: 40 t n .r, /,. _ Amount received: 6,9 , gg Authorized signature: - -? This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 4kot -( 4- Date: 7 30 O01 * Fee methodology set by Tri- County Building Industry Service Board. I: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(1- 1 /02 /COM /WEB�� Vg l L(UU L:( J Buildin;; Permit Application Checklist One - and Two- Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: i p q q 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 CI Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRE F PLAN REVIEW Yes No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. . ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ . El ❑ 3 Verification of approved plat/lot. ❑ El ❑ 4 Fire district approval required. Name of district: • ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El 6 Sewer permit. ❑ El ❑ 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 conforinance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions;. property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. El ❑ ❑ 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- ❑ El ❑ 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. • El ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required . ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS' ' 23 Five (5) 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. ❑ ❑ El 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ El 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 accompanied by 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. I \Building \Permits \BUP- RES- PermitApp doc 03/21/06 440- 4613T(1 I /02 /COM /WEB) Electrical Permit Application . . FOR OFFICE USE ONLY : .- City of Tigard Received 7 9 . " 13125 SW Hall Blvd., Tigard, OR 97223 II I ate/B I 00 -•-• Plan Review IECEIVE* Datem . 0 9* IIIIM. Permit No : Other Permit: 1r 41"--R115,5?„..001/6 2 M , •• Phone: 503.639.4171 Fax: 503.598.1960 TIGARD Inspection Line: 503.639.4175 Date Ready/By. turn. 0 See Page 2 for Internet: www.tigard-orgov Notified/Method. Supplemental Information tI 3020q 4„ t. ':Vt';i:::::tigilANIFII,8 4 11*M::'»:.:fttt,VA ' :' 74 ,7'% '`)f:i4Wka,=4:.:3 •.:!.. -zsT4S.garmraz* .. 4 ,-.1 , -„arNI., . , ..,„..,.,:.,, 0 New construction ikt Addition/alteration/artaFiTIGARD Please check all that apply (submit 2 sets of plans w/items checked below): O Service or feeder 400 amps or more ID Building over three stories. BI p 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards or exceeds 10,000 amps at 150 volts 0 Floating buildings. ., • . t 4,Otr.„ , kt t ,,, to : .ital-tt.,,,o,tot,, V&./Ilkl:4:tor VVV. '.!''VlrIr:13regIird \;IwS.,150: 04arm less to ground, or exceeds 14,000 0 Commercial-use agricultural I - and 2 dwelling Ej Commercial/industrial 111 Accessory building Multi-family Ej Master builder 111 Other: amps for all other installations. O Fire pump. buildings 0 Installation of 75 KVA or 0 - - ` 6114041:1Sailall-WATZ4SVOMPA! 0 Emergency system, larger separately derived system. Ls. ' Addition of new motor load of 100HP or more occupancy. Job no.: Job site address. 13255 s(A) A64- byQ__ 0 Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: - .L (54., ci ?22... 0 Health-care facilities. 0 Supply voltage for more than D Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: we ,t .v 0 Service or feeder 600 amps or more. ;:;'.:Alitll-;:!'iW;:ArMrigt-rt:gtilWi4VZ;i:lzqi.:;ZirapZi Cross street/directions to job site: 4.11... 5 Description I Qty. I Fee. I Total I " New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. addl 500 sq. ft. or portion 33.40 1 Tax map/parcel no.: , Limited energy, residential gAm-vi,.'wo, ..,,,, ,,;,,,, , t:, .y.,„:.... ! A, 14i. - g ; A (with above sq. ft.) 75.00 2 Limited energy, multi-family 015 0 (2)-1 4-tbacla-v-) residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less I 80.30 2 F4*,„s1:7 f-,;ka. lr•AitAtjlrftrEVAWMF'V!' 201 amps to 400 amps 106.85 2 ',I'li'2'5 t VaVATII3,IVIVIVI 401 amps to 600 amps 160.60 2 Name: yt .6,( fer t 601 amps to 1,000 amps 240.60 2 '-'"- Address: ( 3 zcs 5c ,„ As p. 42, Over 1,000 amps or volts 454.65 2 City/State/ZIP: 7) 42.... C -, Temporary services or feeders installation, alteration, and/or - &44,6 0I relocation Phone: (5(97 ) ( — L( 0449 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, I e, rent, or exchan e ding to ORS 447, 449, 670 and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: . Date: 7 Jo o A. Fee for branch circuits with , _ . .. rp' t 6- imittivaw a - 4,i fq,,:r.V.TaVo'rnizIMI °Mtv: above service or feeder fee, , ..,;,,,,,,, . 1 , , 4, : 114;m ,,, ,:‘;,' „., , 665 2 . each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, Contact name: 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) . Reconnect only 66.85 2 E-mail: Pump or irrigation circle 53.40 2 Matigaitnigagratir 6,0**Mititn4,1ktalIfiki; Sign or outl ine lighting 53.40 2 Business name: Signal circuit(s) or limited- energy panel, alteration, or Address: OW 0 e 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 Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75 WistIM!:1 Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. 1 \Building\Permits\ELC-PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: -04:0 NT°I - lig a IDLY:`: 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* ❑ Vaduum Systems* ❑ Other: C,f MIVIERCIAL 3WO,IZK ONEI' Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) • Check Type of Work Involved: I I Audio and Stereo Systems ❑ Boiler Controls ri Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* E . Protective Signaling ❑ Other Total number of commercial systems: • *No licenses are required. Licenses are required for all other installations I:\ Building\Permits\ELC- PermitApp. doc 03/23/06 Mechanical Permit Application - FOR OFFICE USE ONLY • City of Tigard ��C�� V Date/B 7 �, Permit No.: �� r-00 13125 SW Hall Blvd., Tigard, OR 972 �� - Plan Review ' '1 Phone: 503.639.4171 Fax: 503.598,1960 3 Q 2009 Other Permit: 11' Date/By: TIGARD Inspection Line: 503.639 JUL Date Ready /B• orris g ard -or. ov - S upplemental Information CITX OF S ee Page 2 for Internet: www.ti g g TIGAR Notified/Method: Supplemental `_ x � a .„.- �,.. , .:s1 .;, �^ ;, ,�rv*:z;: , ;xs;r,�; y ;,:, a: . -. _ - - N.. •D ". gin :r , I . t x ": °es.• = 's.°c`enx ,m„,: .,<- r- ; �r,.- r,.w- + "=. .�.., „a; - c - -.,-, _ s> s �-�:,�c:�r-• '" ° -5, ` °N., { . T 01;o ' ��`UO L� , • ' ix ERGI FEE* SeareLE - I7SE G^ i rT{LIo :. ,, -„, , ,;z.. a a,. ' s. � '�': ._ 3 .,.,?;• , „: „,,4. ,,,, i -.s.�3 ., ... a��. „,ixtv...„ ,.* ,', ' ^, , k .` i;A tetra aawezta.:,,,, ii,t ,,a t.ii �9,4„ri • i 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. ,• , gig . _.k,..; " -k « :. _.,naE -:M a.,•.: -, n Value: $ L N ,,, a �� CATEGQR are gd?RUCTTQN m. l . ��. �i',�'.,.z »,.:,#:...._ ... �r.. �,.-.:.......,. �_,.._,,-:,«.„; �...», �•, ��a.,.... ��- .- : = °. _ >:';. »x �? ,..�ar . . z' . �.t. s,,+.a5; . "_�:.v.1:.sys��:. - �C`c.�.w:..ac; . .aa.�a :,�' ' + -r; RESII. DENT " MENTW SYSI FEES x y 1- and 2- family dwelling ❑ Commercial /industrial ID Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea Total = f: -t 'r. � :s:�'1 <a::.x,cr;:. �s.�•ra�ra.�, z«�;, ��::.,&<�.s��.,ry��.tz.X"�n�'� " tom ` 'i: -., ,_,�" 't `e"r"e" .?' H,� „� PM", '� " : = 4 JOB SITE INFQRMA ION AND LOCATION ` Heating/cooling Job site address Air conditioning or heat pump 3 2 'S j W 5 � - } De (requires site plan showing placement) 14.00 City /State /ZIP: -'N t 0 a , i 7 22-3 Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: `J`1 Fr' T'F H Gas heat pump 14.00 Cross street/directions to job site: Q. ,LL 2 r S ! Duct work i 10.00 /Q 0 / (� Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances �, � s��a �,. � ,,,� Water heater 10.00 + ^ � ,- ",t y , DF;SCRIP`k7ON OF WORK m , , = ` .Y w , * -,. � � " a � +;. ;;� ta+ sv.. n*, wt. a- m�`�.t,�:�.- St..w�..�,. r,.t;_ ors- ^�.�"I..�. �. ,. ,, .. -r ,, e.4�n..3�n - �;n,, -. Gas fireplace • 10.00 "KT . 13. � /2.1 A ( % i ' Flue vent for water heater or gas i ' 't - L l igh 10.00 D ( Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 : m x. > p , n: ,. -,,,.• 3 , -a Chimney /liner /flue /vent 10.00 :: .''PI2QPER�TYOWNER° - ..._ .. i ®TENAN �� Other: 10.00 Name: -5, w r - L, Environmental exhaust and ventilation 12,55 7 2SS 5 W A j 0 �-/ f Range hood /other kitchen Address: , equipment 10.00 City /State /ZIP: 1-1 l O CA. r l 7-2..-2-3 Clothes dryer exhaust 1 10.00 /4 BO / ! Single -duct exhaust (bathrooms, Phone: (5b3) 620 - 365-7 8 Fax: ( ) toilet compartments, utility rooms) 6.80 r'Q j � G 5 e w- . •,.,,�,.,., -.__ r,, t :r_V -, Attic /crawlspace fans 10.00 - ,. ( rOAMPLWANT 4 , ,v,' :, , r ,,, CON1Tr CT: aPERSON IV W4 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater • Fireplace E -mail: Range ^' ?':�aa.�y i 'r 'Sw- a•-,�s?`r'. „� ,.• vim t�:��•� t� j ;�.n ..,E::�:s�;n� w Fk .:, � , .ti. .: c ;:.. ..s�. a `a�.-:�ao• ^- x.�„r.,/'; �`: N r ; , + r Barbecue m�•:: :- k - ss ,, ift:: 71 .- . - dCO1 TRACTOR<::u , :.... <.: . c't .x.., Business name: Clothes dryer (gas) Other: y gW`e.'1.:`-::=ti ." W K T..aY -'2...:. >s.4 .. �.�.ti:- "..'4i e,'--.e.ww' a.'%,xaaw'+Fe :`s :. i v.. , Address: k °r z-' aMEGI1ri1�I ; ..';EF1RMITT ,F:EES*x ev "" Bx ati City /State /ZIP: Subtotal 26 ao Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 77 ,5 Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) r TOTAL PERMIT FEE II Authorized signature: �_ / - This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ; 'Sr r �� Date: 7O * Fee methodology set by Tri- County Building Industry Service Board 1: \ Building \Permits \MEC- PermitApp.doc 01/19/07 440 -4617T (l I /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: �*:i"a "'�' W*''�r�.e, ��Fx ;3,��`.�'m�,r Total Valuation , '..:. w � taato ee.. h $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. 1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2 Plumbing Permit Application . r FOR OFFICE USE ONLY „RECEIVED DaDate/By: ✓ 0 0 ' / Permit No.: re;Iet) ` 0 3 • City of Tigard w 13 ] 25 SW Hall Blvd., Tigard, OR . Plan Review • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: Inspection Line: 503.639.4175 JUL 0 2009 TIGARD � Date ReadyBy Juris: ® SeePage2for • Internet: www.tigard- or.gov Notified/Method: Supplemental Information -,�� T: ° °,> ^si= ��c. � Y4� �,a:�•*•aa"�- rc�.�.:s:. v». ,�, � : . . y_,_;,..:dr- .:.�aay.- �- �,'�x�'� 3�Mv ,,.,��?•m= �. � °t�%C`.:�' , ; . `, r: *,s' . a Tr PE.t.Orw :° ?`'. ='C71p, 'I t , x x . ya; a ' ., •°..:.- ,' `-FL+`E *.= =SCHE'DUI:iE-;�,:�. fprn�. z .:,,, R a }: �-. ?ar -'?,. xi `a. %` ? i Y.. „.„ :„..Yu „,,:. »t±�+sva,,:.„ ,'r. s -? � ,,,, . � , 4 � �� d t ,. „ „ +-;,, x.„.,, r:. ;s... a r :„, „.. t -. ,...„,s*,s4 „,......, ...,. t �L'au a,. . $•:.a ie t - "z,, ❑ New construction uld�tittr D IviS For special information use checklist. Description 1 Qty. 1 Ea. Total Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) .sx- .,r ° ;� . �srCs :*x` ==o::, r O„I CONSkIAtet "' z"y' �s rs:°.. ��,, �s•. az�� ,?Exi ?; ^ *:_t %�: ya :i ,> ,; t CATEG IJ Wt ; ° ��u-`' "f'y.:.;a SFR (1) bath 249.20 gkl- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building El Multi-family SFR (3) bath 399 00 El Master builder Each additional bath/kitchen 45.00 ❑ Other: , ,.' ^ _;rr -,. . x: =f" ,.;F, . : - :. ; ,, : °;,;.._ Fire sprinkler ( sq. ft.) Page 2 s ` ow ` � OB °STIIE IINF6Ti TION AND LOCATION '' `°" , ft` ,a . , °,.. iawa„c., ,°�c ,, r ;.. :„ ,�. A6ii,Tr,,,„i 7e � a}4 4.. , ytww�:°-sa -t,s Site Utilities Job site address: I3Z5S 'Li A5(-1- Catch basin or area drain 16.60 City /State /ZIP: ' 2: Ei* A (9.(L ci 7 ZZ} Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: We ► at41 Footing drain (no. linear ft.: _ ) Pagc 2 Manufactured home utilities 110.00 Cross street/directions to job site: p-S�f S 1 -- !! 7 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.: r „ ....:... _ _ :, s;s sorption valve 16.60 Ab orpt mt - DF SCR II 'T O N I O F k O;: � , '`� . ' ; = t' :;T t.. . ; �„ ��_ -K _.., . • < .> _ ?,� - , v , It Backflow preventer Page 2 ' 4TS T5 b 11 A '1,sv Backwater valve 16.60 Clothes washer 1 16.60 /6 0 Dishwasher 16.60 "� < �` h �:� = w� - �.��;�, *..,:� _� �...�� .�� :•. ..� Drinking fountain 16.60 ,.. � . � ' l o h ` TENAIVI : .. g ",�, v PROI.. R 1 QW IYER=. r . ;. :w y , r . w, a1'.:� -.�. 'sm . z�?'..�°_." » 4 _ ±aa�:m- �`.��z�; o...,>- :�a -,:, - -,,.- ��aus.`.�.a,�s "3aa ..., , .k,�;vr� ze :r- Ejectors /sump 16.60 Name. worrpiftx.. Expansion tank 16.60 Address: +37 55 SL., 1 irS µ NQ Fixture /sewer cap 16.60 City /State /ZIP: p r -) ZZ's Floor drain /floor sink /hub 16.60 Phone: (563) (pig - 4 1 Fax: ( ) Garbage disposal 16.60 . ? „�,4.. " ;- >.: ; �.�r m �,, k ; a�� °tam x ,. -.,.�� AIM bib 16.60 f R ,R ` a i A 4 MCIANT lea a e. �Caat P AON ,,, l - ._m 0 r, z , " . •� a.. ,.a klz -70 r Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory / 16.60 ‘O Phone: ( ) Fax: : ( ) ' Tub /shower /shower pan 16.60 33 20 E -mail: Urinal 16.60 � N �` „ „ °. ;•. 7§,',, a. 3-z' "' ' x, ' , ; C} re;.°.. v.,;: f; r,;•,ti- °k:.`.:o,`-;.P:°:w,� s; z x ' z A t e t .. q . . .t_ � C O N T B r „ „ , , . : . r i P . 1 < -<, fr Z . , . . . : r ` ' W Water closet [ 16.60 / , , 0 Business name: Water heater 16.60 Address: Other: City /State /ZIP: Subtotal ga Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: • . .• : • -.. s.: Plan review (25% of permit fee) Authorized signature: C , • State surcharge (12% of permit fee) ' 4. /bL. TOTAL PERMIT FEE Print name: is,„,„ L1JE5 ry Date: 7 rt____I T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I } Building }Permits\PLM- PermitApp.doe 12/27/06 440- 4616T(10 /02 /COMIWEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: M":i'''�i; "v - -:,,t�,.ja S- ",; �" mom vow xr s "�`3iw4: *a "� a '.� x: `.„. "u N�`�"' v ".' °.: :" ''. +s5^;>*'ri Y =µ a ' a S-= "` .'. °+t^5"�'v_„�, .: aQ...:$ 'eek Ca) .., , O tSllr -•,. �,„ S><te I1-> <lYtres:a � 4 S = care° oo a =a }Per " t g . a : , .. r _ • ;4 : n�c.� -�, .Y _ ' �s �4smD'v- ^*c,,,. s_,. <r �i .��a a. _,- t s,�i''�, %ss€.- iA-m� Footing drain - 1s' 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 'F t1: Storm & Rain Drain - 1st 100' 55.00 Valuation,, x " Pe<nnt Fee , $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000 00 $72 50 for the first $5,000.00 and $1.52 for each € 1' additional $100.00 or fraction thereof, to and Flxtur o Ite1T1 {� Q ry t Fee(ea) Tottil 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 and including $50,000.00. specially requested inspections - per hour 72.50 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: Are ou capping, adding or replacing fixtures? If "yes", Y PP g� g P g �. „Revrewfor.Plumb�ng Install_ashons�� a.._�.. please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. ' QuantitytttiyE (Fixture�WorkPerforined ❑ Any new commercial building with water service 2" and Fixture Type v , � � � �lteplae greater, except systems designed and stamped by licensed . k,* x.. � . ; Q p edti Adde ' E revtou engineer. Baptistry/Font Bath - Tub /Shower ID New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash - Each Stall CI Medical gas and vacuum systems for health care facilities. Drive Thru ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator E:1 Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash spa tIS0II1riCO- rR1SCrlilgla[1C1 Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. 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'\ Buildin g\Permits\PLM- PermitApp.doc 12/27/06 - MAC r 53' -3' PROPERTY LINE 102/1E0 23' -2' PROPERTY LINE CITY OF TIGARD SITE,PLL NN REVIEW • ' BUILDING PERMIT NO ! /�r r0Lr t- / PLANNING DIVISION: , )---- Required Setbacks: QrApproved r. /..& ❑ Not Approved �— Side: Street Side: p, Front. Garage: Rear: Visual Clearance: 13 Approved ❑ Not A roved Maximum B_Aiding - -1 I5' -0' 5ETBA K ___ _� - his Service Provider Letter Required: ❑ Ye s No -Not r-- e � A I ❑ Received Et) � : ;64 .t Lai' Date: /31 /O'7 ■ ENGINEERING EPARTMENT: Actual Slope: _4:_% Approved ❑ N Not Apo App eyed Site Play; A ❑ prove B �zp �,r A4e Date fl- -9 \ \ I / ------_----= ,4fi�E A OF UJO 'K N otes: dielmred / - r / C ' � , `' .. - -- v ids _ - __a Ir ,O;V -, MASTE I I DEN i,._ . ;i104. 1 PATIO 'I -i l /I d rtirAl -N. 1 1JI<i v 1Q10 r, ... .__. _ _ . PER' j ... p oi it • DINING T 1 0 WIG. i i EXIST It�Ks Y >- S )- �j r WESTFALL I-4OUSE I t 1 g l � 41 i ! Ji , PANTRY i - % 1 i ■ W in 71 FAMILY . - - -- - -- - BEDR_2 M: - - BEDRM. -3- - •t/HH•t• It . I(CIM Lel In F:) • (103) 7114-lilt T ..... f 1 :, 1 I L II . . j . tE I 1 1 I II I • .. II I 9' -6. ■ CITY OF TIGARD ,SIR PLAN REVIEW 05 BUILDING PERMIT NO: J � uc./ianeo nr, arm l l AD�L Street Trees: ['' " Approved 1:1 Not Approved � U1 5 8 1 iIAL p� jlp(I Protected T Approved Q (503) 784 -5815 PD gY� 1 �. ,�iYnc�v� Date: � ytipproved d Notes: 20' -0' SETBACK et 4 13255 ASS DRIVE CITY OF TIGARD 1,111j .-:€13%. 16' -2' PROPERTY LINE . . . . . 4 • SITE X10 I / 8' -i FP ZONE = R -4.5 - ° g LOT AREA =9,000 SF. t,