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Permit .. CITY OF TIGARD MASTER PERMIT - II COMMUNITY DEVELOPMENT Permit #: MST2011 00121 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/31/2011 Parcel: 2S 103BCO2700 Jurisdiction: Tigard Site address: 12120 SW ALBERTA ST Subdivision: Lot: Project: BUCHHOLZ Project Description: 3000 sq. ft. addition. BUILDING Floor Areas Required Setbacks Required Stories. 2 Bedrooms: 4 First: 1662 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 2 Second: 1662 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3324 sf Value: $338,715.60 Rear: 15 PLUMBING Sinks. 0 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 1 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 3 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 2 0 -200 amp. 0 W/ Svc or Fdr: 17 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp. 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System' N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 3324 Owner: Contractor: BUCHHOLZ, KYLE J OWNER Required Items and Reports (Conditions) 12120 SW ALBERTA ST 1 Ersn Cntrl 503 - 681 -4444 TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $9,787.98 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 a • • - .ce 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. • ENTION Ore. •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -' d1 -0010 through OAR •.: 0r" r 190. You may obtain a copy of the rules or direct questions to OUNC by calling 5 3.232.1987 or 1.800.332.2344. ii a .61/(a41 Iss d By: / . t Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspectio ate. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 21 Building Permit Application Residential FOR OFFICE USE ONLY City of Tigard � y . Received .7 /j DateB Permit ��_ i i ° 13125 SW Hall Blvd., Tigard, O' •t I 1 \\ Plan Review A It C ' ' Phone: 503.718.2439 Fax: 503. .1960 1 t ( ' Date/By: t (l Other Permit: T I G A R D Inspection Line: 503.639 \ \�� ti j r . Date Ready/By: Juris See Page 2 for Internet: www.tigard- or.gov •1v l �lo� Notified/Method: . 0 �� -7:::m y Supplemental Information K TYPE OF W • `i r 1 -- / / REQUIRED, DATA: 1 -AND 2- FAMILY DWELLING ❑ New nstruction d emolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ddition/alteration/replacement El Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. - and 2- family dwelling 1=1 Commercial /industrial Valuation: $�ja 1 7 '� J ,. ❑ Accessory building ID Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION. Total number of floors: Job site address: ) 2 I ZL 5 �, \ �1� " ° New dwelling area: _)� _' - ;are feet City/State /ZIP: © ,� ) c,� • '7 22 11 .. `� / Garage /carport area: square feet Suite/bldg. /apt. no.: ✓ Project name: r 4j G. \y \ ,� Covered porch area square feet 'l Cross street/directions to job site: Deck area: square feet 44,Z Other structure area: square feet 2,4 T" REQUIRED DATA: COMMERCIAL -USE CHECKLIST 1 Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all C Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. 11 Ti �..� A c' irV1 C' 0 L)Vv s 2". C'. CJ Valuation: $ { Existing building area square feet New building area: square feet D C HOPERTY OWNER ❑ TENANT Number of stories: C Z Name: 4 4- //t. 3 e,,C4 „\2 t Type of construction: 3 Address: / 2 1 .0 v\/ 4 \ V R.G S 1-. Occupancy groups: City /State /ZIP: `T ; C IR Sl '7 2 2 3 Existing: Phone: (.sD. 5-2 i q / Fax: (c4 1 \) .5773 92c- /4.73 New: - t ❑ . APPLIC PERSON BUILDING PERMIT FEES* / e_ (Please refer tofee'schedule) Business name: (Cj ( Structural plan review fee (or deposit): Contact name: 1 � �� ` 0... FLS plan review fee (if applicable): A ddress: Z '- Total "fees due upon application: City /State /ZIP: Phone: ( ) E -mail: Fax:: ( ) Amount received: PHOTO VOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of TRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: r ;(__A.) Eg Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State /ZIP: Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lie.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained mo t/ within 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Print name: i,L / 1� t , UL 10 Date:7 --c -- j Service Board 1:\Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB) . i Building Permit Application Checklist One- and Two - Family Dwelling , FOR OFFICE USE ONLY City of Tigard Received Permit No.: 1, n 1 3125 SW Hall Blvd., Tigard,OR 97223 Date/By: C ; Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: T I G A R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW %es No 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: ❑ ❑ ❑ 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. 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. ❑ ❑ ❑ 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 Oreton and shall be shown to be as p licable to the Iro'ect under review. JURISDICTIONAL SPECIFICS 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- RESPermitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM /WEB) • Electrical Permit Application . � ��� " FOR OFFICE USE ONLY City of Tigard �.►�� ` ' Date/B a Permit No .: /t _ — W Li 13125 SW Hall Blvd., Tigard, O's F g Plan Review III C ' Phone: 503.639.4171 Fax: 501'1' `60 r1Q ,1 Date/B : Other Permit: Inspection Line: 503.639 `` 1 l• ^� Date Ready/By: Juris. H See Page 2 for I' I G A R D Internet: www.tigard or.gov _` Notified Method: Supplemental Information et) TYPE - OF' W • ' O� ll > > 015‘ CCCC��� ' PLAN REVIEW . ❑ New construction ❑ Addition /altera s, E� G Please check all that apply (submit 2 sets of plans w /items checked below): cement CI Demolition ❑ Other: $ ❑ Service or feeder 400 amps or more ❑ Building over three stories. where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: . ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: , 2 L/A`QQ. y � �` �° 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: - cAjziv,i'..j 0 2 Z ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: /Z CJ ( ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Otv. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) ` Limited energy, multi - family 75.00 2 A 1 `J `IA Q. V`G \ F. \ V i C p,,_,,, 0'\ residential (with abovesq. ft.) , f� t Services or feeders installation, alteration, and/or relocation ' � 5 \ C% Cy „40,,,,,L,.._, 200 amps or less Z -4, 100.70 2 rROPERTY OWN R ❑ TENANT 201 amps to 400 amps 133.56 2 Name: �',1, J� '� 1 \ _ 401 amps to 600 amps 200.34 2 • ` cJ� wx 601 amps to 1,000 amps 301.04 2 Address: `Z 1 '220 W �� Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: / I ' 9 0 Q 77 223 relocation Phone: (W)3) `SZ J 96/ (C-e, \A) s_o s ?own which is not ,l Z / �7.g 200 amps or less 59.36 1 ( 201 amps to 400 amps 125.08 2 Owner installation: This installation is bei. g ,I ade on property that intended for sale, lease, r er - :xc r e 1.1 Co din to ORS 447, 449, 670, and 701. CM 401 amps to 599 amps 168.54 2 f / Branch circuits — new, alteration, or extension, per panel Owner signature: _Li l� ' Date: / A. Fee for branch circuits with . CI A ' CANT ❑ CONTACT PERSON above service or feeder fee ,L 7 42 2 each branch circuit I Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited energy Business name: ( ) w •vn .,.C3 ,� panel, alteration, or extension. Page 2 2 ` ` �1 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed 0 hr min) 90.00 / hr CCB Lie.: Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Number o inspections allowed per permit. I: \Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(1 l /05 /COM /WEB 1, Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n 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 07/01/10 1 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard ��� Received Date/By: Permit No.: ` a , i , �UV, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l0 m Phone: 503.718.2439 Fax: 503.598.1960 . Other Permit• T I G A R D Inspection Line: 503.639 Date/By: � 0 �� Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov �� Notified/Method: Supplemental Information 1 �� A`Sl ` COMMERCIAL FEE* SCHEDULE — USE CHECKLIST TYPE OF WORK I \v\ ` �j � Mechanical permit fees* are based on the value of the work ❑ New construction ❑ Addition/alteration/1 performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: w mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: / Z. ( . G S ,,,,,/ A . \,- S\- (requires site plan showing placement) 46.75 —y` �� 9-.7 Fuace 100,000 BTU (ducts /vents) � 46.75 /�-ilt^.TD City /State /ZIP: / C 2.2 100,000+ BTU (ducts /vents) 54.91 Suite/bldg./apt. no.: Project name: FS J�I��U Heat pump � P (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work ( 23.32 _3'32- - Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel - type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: I Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: i DESCRIPTION OF WORK W ater heater 1 23.32 - 7302- : � I 1 t ` � d \ ^ (� Gas fireplace 3 '' \ + `. 4 b t - J t"C■ c• - - C V . \, )(S '' • Flue vent for water heater or gas fireplace 23.32 �.��iV � ' C �� ! / Log lighter (gas) 23.32 Wood/pellet stove 33.39 �,/ Wood fireplace /insert 23.32 @ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32 I Other: 23.32 Name: J l ��( �, L �,e1\, `2f Environmental exhaust and ventilation: Address: r Z J Ran a hood /other kitchen l � ` " equipment 33.39 City /State /ZIP: 'T '' vi 0 9 7 2_2 3 Clothes dryer exhaust ( 33.39 ''- " Single -duct exhaust (bathrooms, 2 Phone: (Sc 3) 4'Z i ?O / ` c\ ) S' �j /(.7d toilet compartments, utility rooms) 5 23.32 0,% ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. ' t411 '5 Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater r Fireplace E -mail: Range CONTRACTOR Barbecue Business name: �� \ !`j \V{ Clothes dryer (gas) UC� �� V Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal 7_1Q,8 Phone: ( ) I Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) / J , "2 TOTAL PERMIT FEE �, Authorized si nature This permit application expires if a permit is not obtained within 180 g days after it has been accepted as complete. Print name: J /1.. J U L C ( "K Date:7 6,- / /, * Fee methodology set by Tri- County Building Industry Service Board I:\Building\Permits\MEC- PermitAp .doc 09/09/10 440- 4617T(I1/02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: • $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 09/09/10 2 ?iunibing Permit Application Building Fixtures �� ` "� FOR OFFICE USE ONLY City of Tigard R eceived Permit No.: '1 13125 SW Hall Blvd., Tigard •' 1'�' ^_.'' t+� Other Permit No.: \ P ate/By. ( `Y���1 C �" O` Plan Review V Phone: 503.718.2439 Fax: :.1960 �, Date/By: Inspection Line: 503.639.4175 `` N. ' A��Y ® See Page 2 for T l G A R D Internet: www.ti and -or. ov \ U \ ' C'' Date Ready/By: Juris: y g g g J � )s- - 1dG�` �`� Notified/Method: Supplemental Information TYPE OF WOR O �� s c ` FEE* SCHEDULE ❑ New construction ■ R, ��'j4)ion For special information use checklist ,Qg Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement L�'Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: i .Z i 2S) '- A.,1c)ist -,� ,,,‘ •_k, Catch basin or area drain 18.76 City /State /ZIP: ^`� C j 7 Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: l Project name: /TS Jt✓\A, 0 k Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: (0) I Page 2 Z Storm sewer (no. linear ft.:k^JO ) I Page 2 62_,'54- Water service (no. linear ft. ) I Page 2 tc2 , % - Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve �j 12.51 (Z, ^�(� i 1 Clothes washer f 25.02 25,QZ A �rJ D t 't .1 vvc.3 , \ + `v' + Lo `, p Q'''am L.. 0V� Dishwasher 25.02 '�$ k . � -!' \ AA. _�� jtc/ I.r W�I,Z Drinking fountain 25.02 Ejectors /sump 25.02 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 g Fixture /sewer cap 25.02 Name: #� .se, j3. � . n � �,_ Floor drain/floor sink/hub 25.02 Address: (z i Z. S,� , W I + as S Garbage disposal 25.02 City /State /ZIP: ci-C 9 7Z "3 Hose bib 1 25.02 2/762- 0(,)1)S 90C/ -K-•-II) Z*1 S i' 2T- /4 73 Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: / Sink /basin/lavatory O ' 25.02 75,0t, City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 2,7,OZ E -mail: Urinal 25.02 CONTRACTOR Water closet 2- 25.02 W,t' -- Water heater I 37.52 '3'7, r� Business name: 0 \AI' ��� Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal l!t-7,8 1 Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge % of permit fee) 5 •E4- - Authorized signature: `�_ i � TOTA PERMIT FEE ,'3 Print name: / 2 Date• ! -6 - i ! This permit application expires if a permit is not obtained within 180 days `�- l JL/C , after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building\Permits\PLMU- PermitApp doc 10/01/09 440- 46t6T(10/02 /COM/WEB) • ... , .3 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 - 1s 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath - Tub /Shower ❑ Any new commercial building with water service 2" and - Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic-non -food s g q g Disposal - Domestic -food related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: - I:\ Building \Permits\PLMF - PermitApp.doc 02/24/2011 2 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 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing per mits. 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 a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or will be performing work on property I own, a residence that I reside in, or a residence that I w ill reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print N ame of Permit Applicant • C Sig ature of Permit Applicant S Date Permit #: A/54 /l 0001 Address: T;)p q "de Issued by:l•.■A-Y/) Date: 00/ This Copy for Permit Offices " Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: / I,5T) f 0 CWS Service Provider Letter Received: Yes ❑ No E - N/A ❑ $ -r N( iY�c Routed Plans: Original Plan Submittal Date: 7 �q 8 � 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact t at 503- 718 -� -4.� or .S /l.t_ ✓ �{ @ tigard- or.gov) 6 1.1.A, Land Use Case No. Name 61.1.A, t ('\.i7 I 'Z,, I Er Zoning 12 'a . 5" Ca" Setbacks: Front AO Rear K Side 5 _ Street Side ( Garage ❑ Maximum Building Height 30 Actual Building Height * Er Visual Clearance al Easements 1S- ye c ., . ,..424 I P Lands Type: tJ ( Notes: Original Plan: Approved Er Not Approved ❑ Date: 7 t$l I Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (c tact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) ❑ Actual Slope: , Notes: Original Plan: Approved,, Not Approved ❑ Date: 7 ( ( Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City A} borist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) Ly eet Trees Protected Trees Notes: Original Plan: Approved Not Approved ❑ Date: 7 /4 f/ 614.) Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes 'U No ❑ Date Routed to Building: Page 2 of 2 . . .. . , ,• D ( ( i)eS . , ,,, ... _ • � _ . -. - . , � . . I Clean Water Serviced Pilo Number JUL 7.O 11 OeanW ter. Seitvices 9 I (70 3 2 i$ j 1 8itive Area Pro - Screening Site Aesesernent Y d ctloni �. �' ___1161 � 2. Property lnfb_m jttfon (example 1M 4A6401400) 3. Owner info on Tex lot iD(Mn P Name; I Con/pony: _.. . e . ■..W > -•. `I Address: 7 /7.C) A-1,J4 SiteAddresa:� .. .i. ... -. City, State, Zip; d ` . i Oily. State, zip: I r Phone /F. x i ts .. e NOaroat Grose Street: J.> " r -Wall L yy + , rues 4. DeviWpmort Activity (check all that apply) 6. Applicant motto Addition to Single Famii Residence rooms, deck, garage) ID Q Y ( 17 a9e ) Ntrne; a� _ Let Line Adjustment 0 Minor Land Partition Company: II Residential Condominium CJ Commercial Condominium Address; 2Q Vo.r../ 4 It Residential it Commercial Subdivision � a � "r1� Single Lot ComrnertJat City, State, 21p; iel«,.. "*.d/ P ' 9 Mutts Lot Commercial Other _. Phone/Fax! .4 . CJ 4 : � . / (, E -Mall 6. Will the project InVolva any off -site work? °Yes Q't jo 0 Unknown Location sad daacdption of elf -site work 7. Additional comments or Inform *don That may bo ftWdad to understand your project Thle application does NOT replace Grading and Eretter Control Permits, Connection Permits, Betiding Permits, Site Development Permits, DEQ 1200 -C Permit or other permits as laeued by the Department of Environmental quality, Department of Swig Lends endlor Department of the Army COE, All laqul:ad permits and approvals mutt be obtained and completed under applicable local, state, and federal law. By aignkg !hie form, Me Owner or Owner's eulhorted agent or reptesentetive, acknoeledgea and agrees that employees of Clears Wster3wvfcae have authority to enter the proieol Sae el all reasonable times for the purpose of inspecthlp project site conditions and gathering information related to the project site. I cort.%y Mal I em format vAth the Informatlo contained Ii this &w art and ea t o best of my knowledge and belie(, tub information In hue, complete, and accurate Pr}ntlType Name I _ � , Y Print/Type Title -Na„- ''!?(� • Signature ,� i rJ! "al�/1/ Date _7 -J/ FOR DISTRICT USE ONLY . 0 Sensit areas 00110afy eldsten site or withIn 200' of the Ma THE APPLICANT idUJST PERFORMA an ASSESSMENT PRIOR TO 13t3UANCE or • SERVICE pROVIOFR LTTER, If Seneltive Areas exist on the site Or within 200 feet on adjacent properties, a Neturel Resources Aeaesement Report i they also be repelled, , Eased on review of the submitted materials and beat available information Se - 4Nya ereae do not sootier to Mot on elle orwilhtn 200' of the site. This Senetrve Area Pre•Soreening Site Assessment dues NOT eriminala the need le evaluate and ennead Water quality semtittive arena if they are subsequently ' discovered. This doovtmeMwlli serve as your Setvlce Provider fatter as required by ResokAlon and Order 07-20. Section 3.02.1. All required permile and • approveiu must be obtained and completed undereppfioebin local, t3tafe, end federal law. Q Based on review of the submitted materials end best available intormalfon the above referenced pr*t Anal eignlloantly Impact the etdnitng or potentially sanative aree(s) found hear the site. That Sensitive Area Pre-Screening She Aaea5emsnt dam NOT atmhata the need to evaluate and protect adttitlonal water quality sensitive areas r they ere subsequenlfy discovered. Tale document wit serve as your Garvin Prouder letter as required by ReeoluUon and Order 0 • 7 sectlan 8.02.1. Al required pennity and erperovele heist be obtained and completed enter applicable lout, state and federal law. 0 Thls 9ervlce Provider Letter Is not valid unitise CWS approved site :dents) are apaches, I] The proposed ecgvlty doaa not meet the definition of development or the lot wee plotted ateril9f95 ORS 92.04012). NO81TP ASB0SSMENT OR SERVICE PROVID , E rrER IS RE•U . ED. Reviewed by M/ // ...4.. /.Jew Date 7. 7z D/1. 1 :,..,0 w/ I ItIl born I Iinli'w y • ldill`h,rro. urerion,: , 1 ?:i • PInr;52; {5a3) 60I•b'IUv • l-rx: 0;.i'..;} l o 1-44:1 :1 • 1 clea:1 lei refVin @S.QI'ir I ■ Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 12120 SW ALBERTA ST, TIGARD, OR, 97223 Residential - Master Permit 280 Insulation 03/22/2013 00:00 MST2011-00121 PASS Violation Summary: Inspector Contractor