Permit 1! . e CEO �Y ED
iAe
74 a
Community Development DEC 3 0 2010
Request for Permit Action
TIGAIZD CITY OFTIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 6-cet--(2____ (a-s X
Mailing Address: / Z---t- S C J c-i -..1-3____
City/State /Zip: At et L 477/4 U 7 C) G >-
Phone No.: So — 6t2--- 3 3?
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL PERMIT APPLICATION. V ® I
REFUND PERMIT FEES (attach receipt, if available).
2' INVOICE FOR FEES DUE (attach case fee schedule and explain below). / /
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: A/S % .200R - o a V
Site Address or Parcel #: /3 P3( c' et) //41..Cyon/ 7 zte.._
Project Name: 6 4 e - � " L & &J p € i 6 ' J
Subdivision Name: Lot #: 7
EXPLANATION: //0 l � I I9 y / z_//1i✓ /Lc.77/ /[- /&- S , 5 - 6 , 7/
i
p-u ( /2E S L 4r-1 / i N A61 nn/ 27/ 5 Z
£= - "I .5 rao /u - D4,2 a 6 -, /
Signature: Date: 2 ' 3 `, —/ 0
•
i
Print Name: �. c,�.� ' p`e � (Z_- !
Refund Policy
1 The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the budding permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the ongunal Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY _
Rte to Sys Admin: Date //J /� v By , Rte to Bldg Admin: Date `ot�9p /& By t;''
Refund Processed: Date ;(/, By q- Invoice Processed: Date ! By
Permit Canceled: Date /, B/ Parcel Tag Added: Date By
Receipt # Date Method Amount $
1:\ Building \ Forms \RegPemutAction.doc Rev 07/26/07
r / >
Building Permit Application Fi 6 �v, t/
4 Residential POR OI I IC\ USE ONLY
City of Tigard 1 ;p --- �/ . _ ' - R eceived p V O C:577 I ' Permit No ,�7 L
Date/By: �} /� / AN r ...—. oct) ((J L
13125 SW hall Blvd., Tigard, OR 97223 Plan Revte /
. ti ° Phone: 5x3.639.4171 Fax: 503.598.1960 FEB 2 9 1008 Date/By J. ZAK y 09 Other Permit• S�U,41 , x1 � F t.
TI G n R D Inspec :ion Line: 503 639 ���� ®� T6�8Y Date Ready/By. bans• ® See Page 2 for
Intr www.ttgard- or.gov ��ri f 9 i Notified/Method 1K , 0 Su plemental Information
•• TYPE OE WORK • REQUIRED DATA: 1= ANDKAIIIII.YRWELY,G• ..
® New c onstruction ❑ Demolition u n Permit fees* are based on the value of the work performed.
r
(/�/ Indicate the value (rounded to the nearest dollar) of all
❑ Ad •�rtion/alteration/replacement ❑ Other: l k6 Q % ( i equipment, materials, labor, overhead, and the profit for the
• CATEGORY OF CONSTRUCTI N k6
� y e work indicated on this application. Z 5
/ • El 1- and 2- family dwelling El 40 J - ��' Valuation: $ ,�/ 'f /1/ . C) 8
❑ Accessory building ❑ Multi- family V I Number of bedrooms: S
❑ Master builder ❑ Other: 1 _ U Number of bathrooms: 3
_ , '. JOB'SITE INFORMATION AND LOCATION . Total number of floors:
Job site address: /3 g 3 G Stu ,if `e y 04 • - eke 0 ee New dwelling area: 3o y8 square feet
City/State/ZIP: 1I , QQ J 104 G imi ✓ /7223 Garage/carport area: yg.2 square feet
V Suite/bldgJapt. no.: Project name: Covered porch area: 6 / square feet
Cross street/directions to job site: /44 11 s -14 ' Wes 4. eN Deck area: a square feet
46) /k 4.,L ib Ec�j eJ a-d G( Other structure area: square feet
// (/ REQUJRED•DATA:•COMMERCIAL -USE CHECKLIST;
Subdivision: GeArk e.c dr f w d O of Lot no.: 4/ Permit fees* are based on the value of the work performed.
z s L a Z 40 C- d r YO"O 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.
`` , / Y e 4) ? 0 /vi e-
Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER
,...�•.� ❑TENANT' - Number of stories:
Name: e u Caw s �R 4 c�Ct ON eat ay Q�,Y 6444.c_ Type of construction:
Address: ![ 2 60 S Gt`J Y 4 A v e- Occupancy groups:
Y>� s: P
City/State/ZIP: - Tg e a tee. 1 // A 7 7CC z- 8? 7b Existing:
Phone: (5 C ? Z - 3 3 9 0 Fax: (yt 3) C ?Z — .5 Y3 3 New:
' . •• • , g APPLICANT ❑ .CONTACT PERSON . • ' NOTICE
Business name: G A f , eO .7 R f[ c ,ci d/Y ( /,i c . All contractors and subcontractors are required to be
Contact name: �� ,e � G' C t � licensed with the Oregon Construction Contractors Board
q under ORS 701 and may be required to be licensed in the
Address: / ! Z 0 Q S tom) 4/4, Aye - jurisdiction in which work is being performed. If the
K O �z 4 O G _ a o 7 7 O applicant is exempt from licensing, the following reasons
City /State/ZIP:
T� 4 / q 1- apply
Phone: (ro3) 6, If z- 33 ? o Fax:: (Sn 3) 4 T2. - S G 5 3
E -mail: /y t' <. /elZ 7C2,, e Q , C e/-r
• CON�'ItACTOR;
Business name: 6 f - 6,,d fi f,e4.4 .,,,_ f i Ai Co 4 L. - BII]l aq6,' , E S*` - . •
Address: ! Y 400 J W B 6 t /� ;-: City/State/ZIP: -: ! G 2 _ N 7 7 Structural plan review fee (or deposit): ��/��
4 ! z - 3 , 3 9 0 Fax: (S C3) `? z - 5 1/ 3 3 FLS plan review fee (if applicable):
Phone: ( 3) 4
CCB lic.: 3 y 35-6 Total fees due upon application:
Amount received:
Authorized signature: "< This permit application expires if a permit is not obtained . ........4------
within 180 days after it has been accepted as complete.
Print name: /401 G e G 1 a - Date: Z -z t_O g . Fee methodology set by Tri-County Building Industry
Service Board.
I:\ButldingTermits\BUP -RES PermitApp.doc 11/6/07 4404613T(I1/02/COM/WEB)
A
J. Building Permit Application Checklist 'F
One- and Two - Family Dwelling ro OFFICE i o� :.
• City of Tigard Received permit Ni .
q 13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
C . Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
TI 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 - 1'es `' , ; I N N / ;k
I Land use actions completed. See jurisdiction criteria for concurrent reviews. - . ❑ El ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑, ❑
3 Verification of approved plat/lot. ❑ ❑ i\ ❑
4 Fire district approval required. Name of district: ❑ ❑
5 'Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ON
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 . El 0 ❑
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 1
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 ❑ 0 ❑
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 0 ❑ ❑
architect licensed in Ore on and shall be shown to be a licable to the project under review. '
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. ❑ ❑ 0
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 0 ❑ ❑
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 Sit 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, 0 ❑ 0
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 %BwldingTer m41BUP- RES- PermnApp.dac 03/21 /06 440-4613T(11/02/COM/WEB)
Mechanical Permit A lication
pp OFFICE US
ro
a " lUSE. ONLY Ci}�, of Tigard 'p ' : `� Received
`J g ,'11'' Date/By: /
q 13125 SW Hall Blvd., Tigard, OR � Y (J , j r ,
C Phone: 503.639.4171 Fax: 503.5 1 6 V6 Plan Review
L� Other Permit: /
Inspection Line: 503.639.4175 e4 for
Internet: www.tigard o ■ it T I G A R D p `�� ) Date ReadyBy: k la See Page 2 for
r.gov
1 , Notified/Method:
(f itY r N � Supplemental Information
w '7 COMMERCIAL FEE*
. $AE . I9 SE. +
tif New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
' CATEGORY OF CONSTRUCTION Value: $
dwelling RESIDENTIAL EQUIPMENT% SYSTEMS FEEES * '
1 and 2 g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Ea Total
tsr aJ,U$ - SITE>_'10 IA}TI OPF I Qty.
- � �' .• � UN� AO' L °OCi1J'C Heating/cooling
Job site address: 13? X36 5 W 17 lG O� TrA4 de a Air conditioning or heat pump
(requires site plan showing placement)' 14.00
City/State/ZIP: G Qz a OR_ 2 22.3 Furnace 100,000 BTU (ducts/vents) ' 14.00
SuitelbldgJapt. no.: J Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
'/ Gas heat pump 14.00
?
Cross street/directions to job site: 4 a S.A w e s , - One Duct work 10.00
Oise 4 4 1_ Ell /� Q s / Hydronic hot water system 14.00
�Cl d �[ Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
C Flue /vent for any of above 1 6.80
Subdivision:
GR. � . #o�. 5 oar .C�ja weave( Lot no.: Y
Other 10.00
Tax map /parcel no.: Other fuel appliances
-. _ • , "" ~ .DESCRIPTION OF- WORK it Water heater I 10.00
AI �/ Gas fireplace 1 10.00
`'y /`t o 'G Flue vent for water heater or gas
fireplace a. 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
;'; : :`'' Chimney/liner /flue/vent 10.00
•T:..4 „. :i , . _P OED i 0tO t° :.-i: I-, ® TENANT .
Other: 10.00
Name: G eit1z 4.Kstax4. a /. C-- Environmental exhaust and ventilation
Address: / 42 C O S 4 14 -A ] 4 , C - AV r
Range kitchen r 10.00
City/ State/ZIP: 71 + ( .f,, a OR 17062- 0 776 Clothes dryer exhaust ( 10.00
Single -duct exhaust (bathrooms,
Phone: ( 5'63) GI Z. — 33 p 0 Fax: ( Sa3) G r 2 — S'S/3 3 toilet compartments, utility rooms) L i 6.80
`' lit CANT 0,: c0 PERSON Attic/crawlspace fans 10.00
Business name: 7L Other: 10.00 _
CLT2- Os Seu.,6 - 0),I 4 /Nt. Fuel
Piping
Contact name: `f,CN G ea-1i $5.40 for first four; $1.00 for each a dditional
Address: / 9 Z 0 6 S CeJ 1/4.. li A CJ v. Furnace, etc. )
Gas heat pump
City/State/ZIP: I4 a C4 1 F I/y D 4 7042 - g 770 Wall/suspended/unit heater
Phone: ( O3) G r Z- 3 3f O I Fax: : ( Sp 5 6 P L- 5-i '3 3 water.heater I
Fireplace
E LCe t& edice -c e
• CC if/ Range I
i titi 4.cC� ffiZ7 i`o1 : , : :'' 1i;..i :. Barbecue
Clothes dryer (gas)
Business name: Otie r Ib 4.1e
O ' x / Q Other:
Address: ! ,. «a ,;..
City/ State/ZIP: 4 a / Cite e t( v /< L 7 6 2. Z Subtotal
Phone: (S6 3) 4,5-51 Q Z 7 ( Fax: (503) G So Z 7 ? 3 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
)
CCB lic.: %' 2,` 5 / l State surcharge (12% of permit fee)
AiTOTAL PERMIT FEE
Authorized signature: �� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: g.,,,, 1 5 Date: Z-24-6 8 • Fee methodology set by Tri -County Building Industry Service Board
I: 1Building\PermiuMMC- PeratitApp. oe 01/19/07 440.4617T(I1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
r Commer j cial Fee Schedule: • ';
•
`''Qtllua�r'x�n .Y,. de 1: t•' '
plc ' T`• '. • " i7
n:'��:� erm 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
•
Plumbing Permit Application
. Building Fixtures ,� F (Zl "r� FOR OFFICE USE ONLY
lihi City of Tigard " ` ` J L uI `' 0- ed No
■ 13125 SW Hall Blvd., Tigard, OR 97223 ate/By �� , �� /��� ��
FEB F t 2 U I Ian Review
Phone: 503.639.4171 Fax: 503.598.1960 O ther Permit No.'
Inspection Line: 503.639.4175 ���- 01- DateBy e f • _ 7
T I G A It D �J t . t � , to Ready/By: Rids. ® See Pa e 2 for '
Internet: www.tigard- or.gov 18 .i;� �ed/Method Supplemental Information
TYPE OF WORK, . . • FEE * SCO.DM . ' • . • .
O New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
•
• . CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Oil and 2- family dwelling ❑ Commercial/industrial SFR (2) bath ' 350.00
❑ 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: ` 63C, S (J /Tra /C 4 off / �RQ QC ,f Catch basin or area drain 16.60
City/State/ZIP: S `7j a 4.d CA ? 7 22 3 Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: ✓ I Project name: Footing drain (no. linear ft.: ) Page 2
'/ Manufactured home utilities 110.00
4 f /
Cross street/directions to job site: /` f ICJ e f t ody / Manholes 16.60
0 On 4A- 4 *0 �Q - wo D d Rain drain connector 16 60
Sanitary sewer (no linear ft.• ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 4 CQ .6� Rcwc„ s . E ,4 er� _ Lot no.: Y Water service (no. linear ft.: _ ) Page 2
Fixture or item
Tax map /parcel no.: 2 51(Z o C O $` y (tN
Absorption valve 16.60
`' ' --• DESCRIPTION' O1! WORK' Backflow preventer Page 2
Ate t•. !'f O s K c Z /3 s f c Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
of f PROPERTY OWNER-. . . - .. , ❑ TENANT
Ejectors /sump 16.60
Name: G cRfZ a s fA. t(� // C. /au, Expansion tank 16.60
Address: 1, Z O o S w i/ Ave_ r_ Fixture/sewer cap 16.60
City/State/ZIP: 7.-4 Q. jf 7 (, K 6X 1 2 04 2-- °p 7? ,3 Floor drain/floor sink/hub 16.60
Phone: ( 3 (p L- ? 3 9 p Fax: ( p3) 4r 2 _ �- 33 Garbage disposal 16.60
• ' N APPLICANT .. Hose bib 16.60
❑ CONTACT PERSON
Ice maker 16.60
Business name: a , en,I 4 2-- G A.IS•yL`4a-(40") A &C
• Interceptor /grease trap 16.60
Contact name: le e Al G TA. t7- Medical gas (value: $ ) Page 2
Address: / ! Z cf) Q sG.) Y 4 '-S A u>c Primer 16.60
City/State/ZIP: li 4 j, .C.0 . O i2... f 704 z- g 2 2 6 Roof drain (commercial) 16.60
Phone: ( S6' to 1 2. 3 3 ga Fax: : (563) GT 2 -fY3.3
Tub/shower/shower
Sink/basin/lavatory t 16.60
Tub /shower /shower pan 16.60
E -mail: < < e x k G e r f 2 G D, Cos•-r Urinal 16.60
- .CONIIRACTOR- . . , , Water closet 1 16.60
Business name: 7 -,. 1,, .t. /01".... `�� Water heater 16.60
Address: / O. /3 G x 2 2 y Other:
City/State/ZIP: hi s t 4 i Ntitl 64 9 7 c Cg Subtotal
'o u F ax: (Y03) `s-Q „ Minimum permit fee: $72.50
Phone: (5
3 93 � ' Z 3 $ ! SZ /,? Residential backflow minimum permit fee: $36.25
CCB Lic.: / 63 7 9 2 Plumbing Lic. no.: 3 -25 fie Plan review (25% of permit fee)
State surcharge PERMIT fee)
Authorized signature: TOTAL PERMff FEE
Print name: r 14it54 i 71A. e• Kto 7 Date: Z-z f.. $ This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Trl -County Building Industry Service Board.
I.\ Building\Permite\PLMF- PermitApp doe 12/27/06 440.4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information • . ,
Fee Schedule: Residential Fire Suppression Systems:
Sitei ZTtilit[es•. •. . Qty- Fee (ea) Total Square Footage: Peri<nit
Footing drain - l° 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' 46.40 311 7
Water Service - 1st 100' A., :d to r -t 045 03,'- lop k,�+ /' Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' Valuation: Permit Fee:. .
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
•
- Fzzture.or Itenif ' ' • - Q ty. 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 firsr$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: Plan Review forPlumbing 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 *. CI Any new commercial building with water service 2" and
.e.fi y,,� a Q8' ty ' ( tir' e). orkip f jhE'dt. greater, except systems designed and stamped y i
' a.•. aiitii �' b: Tix r," h�U' ' licensed
by I'
i
sy%
f. •.'� .. n; .,7,.,= _, *,,...;. - :, .'if'' . Rtiii ee{' engineer.
"' < :. ;. ¢ -P evi3u#. ' apped Added.. Eiashngr ' ❑ 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.
-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:
r\BuildingTermits PLM- PerrnnApp.doe 1787/06
Electrical Permit Application. � q i ;1 r; i, `1 ? j FOR OFFICE USE ONLY
n Received
r a City of Tigard , ,1� + � '' nUid Date/B . ' i •7 ,d I.1� Permit No : Grua SW Hall Blvd., Tigard, OR 97223 2 An �.
C Phone: 503.639.4171 Fax: 503.598.1960' td „ ft Plan Other Permit
Ins ection Line: 503.639.4175 WIC* T � ( ' ` ��-
li D
P r e n, D Ready /By tuns ® See Page 2 for
T 1 G A
Internet: www tigard - or.gov P III.0 ` �'d d Notified/Method Supplemental Information
- . • • . . TYPE,. OF WORK.
'New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whtems checked below).
❑ 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
I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
Multi - family 0 Master builder 0 Other:
0 Fire pump
0 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 ", "I -3 ",
Job no.: Job site address: / 3 83G S4.3 144 0. 1 ]"t I00HP or more occupancy
' ❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: 7' Qom" 64- g 7 2 Z 3 ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. -
//
FEE' v SCIEDUIsE
Cross street/directions to job site: x 4L1 S f. �e f r Description I Qty. I Fee. I Total I •
! New residential single- or multi- family dwelling unit.
DA' t q e e ' a+ , le er e C Includes attached garage.
Subdivision: // 1 / Lot no.: 1 1,000 sq. ft. or less / 145.15 4
eiti.L /f Ike D .i �(- r s.! c „" L
�( 1
Tax map /parcel no.: a s log O C 65-/0-ti Ea. add'I 500 sq. ft. or portion 33.40 ►
• Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) ' 75.00 2
t /� ,( � L energy, multi - family
/�l 6 '4'� residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
[X( PROPERTY OWNER (•. • , .0 TENANT . 201 amps to 400 amps 106 85 2 •
Name: G eti ¢L e0, 32(A w e 'jai wise 4 l ° G, 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: / ?zoo S ' ' 4 -rte Over 1,000 amps or volts 454.65 2
City/State /ZIP: 7' Q f , 11, y OR 7 7Q a Z — 82 2 O Temporary services or feeders installation, alteration, and /or
/ relocation
Phone: (5 15 6? 2 -- 3 3 90 Fax: (3 (o f z _ '5-Y33 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
0•.APPBYCANT: . - • I'" . 0 . CONTACT PERSON' ' above service or feeder fee,
each branch circuit 6.65 2
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
Phone: ( ) Fax: : ( ) 90.90 2
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53 40 2
. • CONTRACTOR' , - .t, . • . . . . Sign or outline lighting 53.40 2
< / 1 .e / Signal circult(s) or limited -
Business name:
D ec s ".,,,,L e (ec �a L h G, energy panel, alteration, or
Address: / D G 3 7 S E F� //e .< ?d , extension. Describe: Page 2 2
City/State/ZIP: "9 44( K .( O X ? 2 2. 2 Z Each additional inspection over allowable in any the above
/ Per inspection 62.50
SD
Phone: (') 7 8c- 0 884 Fax: (5 3) 784 '2. ei n
G Investigation per hour (I hr mm) _ 62.50
CCB Lie.: Y3 93 s' Electrical Liie.: : 3 2 (((, Suprv. Lie.:,Z s / v Industrial plant per hour 73.75
�i.�
ELECT RTCtiB $ :.. c ti FEES
Suprv. Electrician signature, required: Z2464, •K�is.
d: Subtotal:
Print name: '04 V C �/.ex K / e; v Date: 2 -Z f - Q g Plan review (25 % of permit fee):
State surcharge (12% of permit fee):
Authorized signature: /‘s...... TOTAL PERMIT FEE:
Print name: /i tee Date: Z G (� This Permit application expires if n permit is not obtained within 180
/� days after it has been accepted as complete.
• Number of inspections allowed per permit.
I \ Building+Pernits+E1.C- PennitApp doe 05/23/06 440-4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information • .
LIMITED ENERGY PERMIT FEES:
_ _ .. rear., - �- :xx;olvLY: - _
Fee for all residential systems combined $75.00
Check T e of Work Involved:
A udio and Stereo Systems*
E Burglar Alarm
[/Gara Door Opener*
d Heating, Ventilation and Air Conditioning System*
Er Vacuum Systems* //
Other. Ate'veJ ez
WORK.ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \BuildingTermiu\ELC- PamzApp.doc 03/23/06
5_10 1
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WARNING:
OBTAIN LOCATES PRIOR TO ANY
F �v, EXCAVATION
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Elev 216 W n
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SW HALCYON TER
RACE
GERTz C P
HOME SQUARE FOOTAGE IN
MAIN FLOOR =1446 SQ.FT. BUILDING
UPPER FLOOR = 1602 SQ. FT. / Zi
CUSTOM HOMES SINCE 1977 ��
TOTAL = 3048 SQ. FT. (503) 692 -3390
GARAGE = 437 SQ.FT. 13836 SW Halcyon Terrace
Lot 4 Gertz Homes at Edgewood
SCALE 1' = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 4/8/08
/3R34 S W I c7 ce
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: M'S7 .2006 coo i 8 rk.5
PLANNING DIVISION:
Required Setb ks: 121 Approved, ❑ Not Approved
Side: Street Side: L_
Front. Garage: as Rear: l<
Visual Clearance: [Approved ❑ Not Approved
Maximum Building Height. . feet
('WS Service Provider Letter Required: ❑ Yes 0 No
/ t ed
1L1LL( �� Date:
ENGINEERING DEPARTMENT:
Actual Slope: % Approved ❑ Not Approved
Site PIa ‘,,( 0- A pproved ❑ of pproved
By: /2, ' Date: 4 Z. 65
Notes: ar(5,; t ti -ca e
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO:
Street Trees: Approved ❑ Not Approved
- ProtectedTrees_" a Approved ❑ No Approved
By: / dd �r�y Date! • 4-I ®p
Notes: !
5 S0
Elev 212 I
"
Elev 210 i j l : • ..,_.w. ,14j ( \
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' y 1 .4)1 ' • . 12.50 -
o y //
Grovel Drive .. . CO. _. - . ....
a for Erosion 3 �� � � d'
I ( 41. N
a ' /, otkA5P-.. o
/ ���/ WARNING:
/
L 1 PL LOCATES PRIOR TO ANY
:\ . EXCAVATION
: be 10 �
Elev 216 20.00
SW HALCYON T
CONSTRUCTION
HOME SQUARE FOOTAGE GERTZ COM PANY
INC.
MAIN FLOOR =1446 SQ.FT. BUILDING
UPPER FLOOR = 1602 SQ. FT. /'I
CUSTOM HOMES SINCE 1977 S.
TOTAL = 3048 SQ. FT. (503) 692 -3390
l GARAGE = 437 SQ.FT. 13836 SW Halcyon Terrace
Lot 4 Gertz Homes at Edgewood
SCALE 1' = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 4/8/08
/3436 SW G I /Pr,�cce .
CITY OF TIGARD e SIT PLAN REVIEW
BUILDING PERMIT NO.: M'? 7 acc)S c oo i
PLANNING DIVISION:
Required Setb ks: Er Approved 0 Not Approved
Side: Street Side: /
From. Garage: 211 Rear:
Visual Clearance: [Approved 0 Not Approved
Maximum Building Height. feet
C`W S Service Provider Letter Required: 0 Yes 0 No
� �� 4 / � ed
a: y�fU..•�� �c-fi Date:
ENGINEERING DEPARTMENT:
Actual Slope: .L.% Approved 0 Not Approved
Site PIa : r -Approved ® of pproved
/ i (. - Y Date:
Notes: c A ar c �4i��c �:�,.c cwo c
CITY OF TIGARD a SITE PLAN REVIEW
BUILDING PERMIT NO:
Street Trees: Approved 0 Not Approved
Protected Trees: a Approved ®No Approved
,'der Date` �
Notes: I
Building Division
One & Two - Family Dwelling
T I G n R D Fees Checklist
PERMIT INFORMATION: ,
Permit #: 9175 % ,?Coe coo/8 Plan #: Date:
Site Address: /35 5& fi4 /9,c t ?crrarce Parcel #:
Subdivision: A / f . 6-Jse.2 J Lot #:/ Zoning:
Jurisdiction: 'y Setbacks: Front: 2,, - Rear: / 5 ' Left: �' Right: S -
Class of Work: ,/) 14,. Stories: 2 First Floor: / 9 4/ 6 q°
Type of Use: 3 F Height: 25 ' Second Floor: 160 P'
Construction: .g / " Floor Load: 50 ,0 Third Floor: -E3
Occupancy Group: X - 5 Dwelling Units: ) 4 Bonus Room: -63-
Valuation: 16 315 /// . 08 Bedrooms: 5 Total Floors: c
30 /S 0
Bathrooms: 3 Basement: -1:-
Decks: 2 35, Garage: 4 12 it
Porches: 6./ 9 Other: -el-
' FEES:. ' Description: . - .Fee'Amount: ' : - - Amount Paid: Balance' Due: '
Plan Check: Building: I / -4 / 1 . 50 •' "> 1 3 6
Extra Set: NA' NA ti 4
Permit: Building: / /ci , 56 /3/9.56
Tax: ROC,. .35 aqo . 35 -
Metro CET: 3'4$ , /3 3,c>./3
School CET: 36 3o /y, .00
Mechanical /13 YO _ // 3 Yo
' Tax: i3-60 /3 - CO
Plumbing: P7 3o/c2 oo 399. c�
Tax: x .88 6/7 .88
Electrical: 3/2./5 /2 , 75
Tax: 1 31.'-/.5.' • 3?. - `/S
Low Voltage: 35' 00 -. 6:C1
Tax: 1.00 l
CDC: CDC Ping. Rev.: 4/6 . 00 9‘. oo
CDC LRP Fee: 6 . CEO G . ev
SDC: Parks: 99/2, OG 4 1 8/,2 . av
TIF Res.: P1806 .06
TIF MT: U OQ ��
Erosion Permit: / /2 UO I //2 6D
Erosion CWS: 36, c/p / 36. 9
Erosion COT: i 36 . 516 , - C/O
Water Quality: ,"fi ./1/..14
Water Quantity: y,- 44-
SUB- TOTAL: ,t /3 / ,? 98. v3 $1 /a, 4/9s. 03
Sewer: Permit:
Inspection:
SUB - TOTAL:
TOTAL MST & SWR:
I\ Building \ Forms \ResPlanCheckFeesdoc 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 j Qty - I Fee(ea.) I Total
New 1- & 2- family dwellings Heating/Cooling
(includes 100 ft. for each utility connection) Air conditioning or heat pumps 14 00
SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) I 14 00
SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) 17.90
SFR (3) bath 3 399.00 Gas heat pump 14.00
Each additional bath /kitchen 45.00 Duct work 10.00
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) I 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
Gas fireplace I 10.00
Footing drain - each additional 100' 46.40 Flue vent (water heater /gas fireplace) 2 10.00
Manufactured home utilities 110.00
Manholes 16.60 Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Rain drain connector 16.60 Wood fireplace /insert 10.00
Sanitary sewer - 1 100' I 55.00 Chimney /liner /flue /vent 10.00
Sanitary sewer - each additional 100' 46.40 Other: 10.00
Storm sewer - 1 100' I 55.00 Environmental Exhaust & Ventilation
Storm sewer - each additional 100' 46.40
Range hood /other kitchen equipment 1 10.00
Water service - 1 100' I 55 .00 Clothes dryer exhaust 10.00
Water service - each additional 100' 46.40
Fixture or Item Single duct exhaus r"
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 I 16.60 Other: 10.00
Fuel Piping
Dishwasher I 16.60 * *($5.40 for first 4, $1.00 each additional)
Drinking fountain 16.60 Furnace, etc. I ** r
Ejectors /sump 16.60 Gas heat pump ** _
Expansion tank 16.60 Wall /suspended /unit heater *5
Fixture /sewer cap 16.60 Water heater I **
Floor drain/floor sink/hub 16.60 Fireplace I **
Garbage disposal 1 16.60 Range i **
Hose bib 'd. 16.60 BBQ . **
Ice maker I 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 2/0 5 - 4 16.60 Subtotal: $ I )1.'40
Tub /shower /shower pan ,' Jo / 2 '-/ 16.60 Minimum Permit Fee $72.50 $
Urinal 16.60 Plan Review Fee (25% of Permit Fee) $
Water closet 3 16.60 State Surcharge (12% of Permit Fee) $ / 3. 60
Water heater j 16.60 TOTAL PERMIT FEE $
Other:
Other: •
Plumbing Permit Fees ELECTRICAL FEES (residential single- or multi - family)
Subtotal $ 3 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'l 500 sq ft. or portion S 33.40 1
State Surcharge (12% of Permit Fee) $ z-/-� , 5 S Limited energy, residential 1 75.00 2
TOTAL PERMIT FEE $ Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Electrical Permit Fees
Subtotal: $ 3e) 15
Plan review (25% of permit fee) $
State surcharge (12% of permit fee) $ `/E . `15
TOTAL PERMIT FEE $
I \Building \ Forms \ResPlanCheckFecs doc 01/19/07 Page 2
RESIDENTIAL PERMIT APPLICATION REVIEW
Permit No.: in srr 240 6 - O& :)/
Site Address: /3 3 6 set) 1/4 /C. t oy1 7 enrei ce
Subdivision: ( g e 4 ..� � _ , -
Lot No.: L
Contact Name: �( (rx,
Business: her (6-'1 D4r - . 1 ^ e .
Street: /9 200 SC ��� 441 �1Lc'
City: r I c)4 /C< i h State: (S Zip: 9 G 7 2v
As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and
plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or
"complex" as defined in ORS 455.467 and 455.469.
[ The application is complete.
n The application is incomplete for the following reason:
❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above
information is reviewed and /or approved.
❑ The submitted plans cannot be reviewed until the above information has been submitted
and /or approved.
n The plans are deemed "simple ".
The plans are deemed "complex ".
Signature: tj /rci✓og
Name: Brandon Shaw Date
Title: Plans Examiner
Phone: 503 - 718 -2425
E -Mail: BrandonS @tigard - or.gov
I.\ Building \ Forms \RES- PcrmitAppRcvw -Blank doc 1/18/07