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Permit CITY OF TIGARD MASTER PERMIT 14 -- " 2 '- COMMUNITY DEVELOPMENT Permit #: MST2011 -00153 Date Issued: 09/14/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S112CA07200 Jurisdiction: Tigard Site address: 7947 SW ASHFORD ST Subdivision: ASHFORD OAKS Lot: 26 Project: BOWEN Project Description: Convert attic space to bonus room and laundry addition BUILDING Floor Areas Required Setbacks Required Stories 2 Bedrooms 0 First 0 sf Basement 0 sf Left 0 Parking Spaces 0 Height 25 Bathrooms 0 Second 430 sf Garage 0 sf Front 0 Smoke Dwelling Units 0 Third 0 sf Right 0 Detectors Yes Total 430 sf Value $43,817 00 Rear. 0 PLUMBING Sinks 0 Water Closets 0 Washing Mach 1 Laundry Trays 1 Rain Drain 0 Urinals 0 Lavatories 0 Dishwashers 0 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0 Tubs /Showers 0 Garbage Disp• 0 Water Heaters 0 Water Lines 0 Drains Catch Basins 0 Bckflw Prevntr. 0 Footing Drain 0 Ice Maker 0 Hose Bib 0 Backwater Value 0 Drywell- Trench Drain. 0 Other Fixtures 0 Other Fixture Units MECHANICAL Fuel Types Air Conditioning. N Vent Fans 1 Clothes Dryers 1 Heat Pump N Hoods 0 Other Units 3 Furn <100K 0 Vents 0 Woodstoves 0 Gas Outlets 0 Furn > =100K 0 ELECTRICAL Residential Unit Service Feeder Temp SrvcfFeeders Branch Circuits 1000 sf or less 0 0 -200 amp 0 0 -200 amp 0 W/ Svc or Fdr 0 Ea addl 500 sf 0 201 -400 amp 0 201 -400 amp 0 W/O Svc /Fdr 2 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: ALT SF VB R -3 430 Owner: Contractor: BOWEN, GREGORY R & ANDREA L GIBB CONSTRUCTION & REMODELING INC Required Items and Reports (Conditions) 7947 SW ASHFORD ST 15755 SW SERENA WAY TIGARD, OR 97224 TIGARD, OR 97224 PHONE PHONE 503 - 407 -9686 FAX 503 -549 -8986 Total Fees: $1,955.49 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 .. - in a • •.nce 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 .:ys ATTENTION e egon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR :52- 001 -0010 through OA' • I' -'090 You may obtain a copy of the rules or direct questions to OUNC by calling 50 or 1 800.332 2 , Iss • - • By ; �. : Ai i /. ' � / Permittee Signature: • � I Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. Building Permit Application Residential �j r,� FOR OFFICE USE ONLY R eceived City of Tigard DateB / Permit No. l - ° 13125 SW Hall Blvd , Tigard, v 1 Plan Rev�e� 0 ' � Phone: 503.718.2439 Fax. AT s. ' : '4. it 1 �Q� DateB tt�>r•IIi iMl Other Permit T 1 G A R D Inspection Line' 503.639 4175 Date ReadyTy Juns See Page for Internet: www tigard- or.gov G 1O Aran �� -- S ; Supplemental Information TYPE ,` OF ' I REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction Sgemolition * based the performed. Permit fees are ase on te value of the wor �'tt p Indicate the value (rounded to the nearest dollar) of all `( Addition/alteration/replacement ❑ Other: • �� equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTI sl Q1 �© work indicated on this application. tIC pp Valuation: $ !) X( 0- 1- and 2- family dwelling ❑ Commercial/induis� rial Ol Q / t �1 vls Number of bedroom ❑ Accessory building ❑ Multi - famil .,cs1, G El Master builder 0 Other: \ Number of bathrooms: JOB SITE INFORMATION AND LOCATI�N Total number of floors: Job site address: )c3 Y 7 la A9f �p4 •5r. New dwelling area: square feet City /State /ZIP: 776,412-0 Y O A. • 9 72-2- y' Garage /carport area: square feet Suite/bldg. /apt. no.: •----- Project name: Covered porch area square feet Cross street/directions to job site: Deck area square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. pop, rrv4 eyG 131, s /2N1 [� -1 Valuation: $ ( Op 1 ri �J /t v 'Ju5 ) Existing building area square feet Al K N /7 New building area: square feet V] PROPERTY OWNER ❑ TENANT Number of stories: Name: Gib 4 q , f p e--N/ Type of construction: Address: 7 f L f 7 5 t../ As 1-1-Fpit:/) r S r 7, Occupancy groups: City /State /ZIP: 77 es4yllf / t Y • 972Z `p" Existing: Phone: ( $19:3) 3 0 7- 01 Z 7 Fax: ( ' ) New - 14 APPLICANT '?CONTACT PERSON BUILDING PERMIT FEES* / (Please refer to fee schedule Business name: Structural plan review fee (or deposit): Contact name: t p3 -3 ( y - ra..4Ln..ti 3 „HOC L.r .-at. FLS plan review fee (if applicable): Address: / 5 y 7 sr- s -,ems C • a� City /State /ZIP: 71 or-409 011 . �?Z Total fees due upon application: Phone: (5b3) Ito 4- - 9 f Fax: : ( ) Amount received: E -mail: at gg�rsiv -4 trt Cv c.a�rsr. Per PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top mounted PhotoVoltaic Solar Panel System. Business name: c7r31=2 / ! , � ., 0�Lff * ..41-` f � C Submit two (2) sets of roof plan with connection details Cam”' and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City /State /ZIP: t Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ) ( ) Fax: State surcharge (12% of permit fee): $21.60 CCB lie.: /&1/4O % Total fee due upon application: $201.60 Authorized signature: / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: "r ( Date: t .. Fee methodology set by Tn- County Building Industry '�� f Service Board. I•\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 l /02 /COM/WEB) I s. rit Building Permit Application Checklist One- and Two - Family Dwelling FOR O FFICE USE ON lig City of Tigard Received Permit No '� 13125 SW Hall Blvd , Tigard, OR 97223 Date /By C l '- Phone 503.718.2439 Fax 503 598.1960 Associated permits TIGARD 24- Hour Inspection Line 503 639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet www tigard -or gov ' ❑ Other - j THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes j 'No i N/ 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. I1 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ i 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 diiensions, 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 Ore. on and shall be shown to be applicable to the .ro'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. I \ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11/02/COM /WEB) Electrical Permit Application FOR ()HA: I ;. tJ F (aiv'I,1' Received III City of Tigard -',- ''.�, Dateive g f 0 ` If P ermit- • Nb. ° 13125 SW Hall Blvd , Tigard, OR 97223 s ti:r Cl °' Plan R evie w A ' _ Phone 503 718 2439 Fax 503 59S -196t , , Y,- -'i Date /By Other Permit: Ti GA K D Inspection Line 503 639 4175 `�- , :,+ `- • , C,. Date Ready /By tuns See Page 2 for Internet www tigard-or gov c', �, P� Notified/Method TYPE OF WOR Supplemental Information K C,' \ P LASi ,. ' .' - . r� "k �,�( ,�," REVI ,, , e. k1 h.?1 Please check all that apply (submif2_ sets of plans w /nems checked below ❑ New construction ddition/aiteratio ( r p uck ent��;."� ' p ) , t. ,,.d r- ❑ Service or feeder 400 amps or more ❑ Building over three stories Demolition ` wh ere the available fault current ❑ 0 t .: - '' lbl '0 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 0 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings. ❑ Fire pump Ti Multi- family ❑ Master builder ❑ Other: ❑ Installation of 75 KVA or ❑ Emergency system larger separately denved system JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of l OOHP or more occupancy Job no • Job site address 7' /7 5.,,-,,, 5.,,-,,, r J{ t 6 ,.v e _ ❑ Six or more residential units. ❑ Recreational vehicle parks City /State /ZIP' 7-2104-642 f Oil . 7 0- 2.-"( ❑ Health-care o catities ❑ Supply 00 vo lts nominal. voltage for more than ❑ Hazardous locations. 600 volts Suite /bldg /apt. no.. Project name' ❑ Service or feeder 600 amps or more., . FEE SCHEDULE - ; - Cross street/directions to job site Description I Qty. I Fee. I Total I * _ New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no. 1,000 sq ft or less 168.54 4 Ea add'I 500 sq ft or portion 33.92 1 Tax map /parcel no.. Limited energy, residential DESCRIPTION OF WORK (with above sq ft) 75.00 2 Limited energy, multi - family 75.00 2 A VID f% %.,mss LA e„ e) t ,, „� residential (with above sq ft ) r Services or feeders installation, alteration, and/or relocation 200 amps or less 100 70 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps or ,_ 1 10 33 0 . 7 5 0 33.56 2 � 401 amps to 600 amps 200.34 2 � Name: 2A & 4 'v ENf 601 amps to 1,000 amps 301.04 2 Address '7 7 5, t f . 4 Over 1,0 amps volts 552.26 2 is eg Temporary 00 services or feeders installation, alteration, and/or City /State /ZIP: ��� e".-6.2_,. '- I relocation Phone: ( V) 4t37 P f --/ Fax: ( ----)--- 200 amps or less 59.36 1 v� 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168 54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new, alteration, or extension, per panel 4 Owner signature: Date: A Fee for branch circuits with APPLICANT ❑CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit '� B Fee for branch circuits without Business name' (,diaryyL r 4 t.1, ,._t -, , 1 service or feeder fee, first 1 56.18 yy branch circuit " � ; ; i �. 2 Contact name: Each add branch circuit 2 Address: ( 5-7 c 5, d`' -- ,., C. I - - Miscellaneous (service or feeder not included) Cit City/State/ZIP � - � - y t Each manufactured or modular 67.84 2 Y l C t d) - {1.J,) r - 1 1 ,2 dwelling, service and/or feeder Phone. ( ? tf� �- &vs''(: I Fax • ( )- -� Reconnect only 67.84 2 Pump or irrigation circle , 67.84 2 - E -mail: 4 'C ?tr 5't;`12-4.sCir C� ° 2., c.'T, kJ el* Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy ` Business name. 11_,65 11_,65 (.�t� � �'% ..--. _panel, alteration, or extension Page 2 2 Each additional inspection over allowable in any of the above ('6 S'�e,,,i. 4 S t De jar) inspection (1 hr mm) 66.25/ hr Address V T ls.<, Investigation (1 hr min) 66 25/ hr City /State /ZIP: 9k-t 9 -7 30G Industrial plant (I hr min) 78.18/,hr Phone (ST 7) ( ( I Fax: ( 603 ) 3?/-- r/ Inspections for which no fee is 90.00/ hr specifically listed (/ hr mm) , CCB Lic.: /61 Q 9 g Electrical Lic.: Z 1 J . 5 . c Suprv. Lic. 511 3$ ELECTRICAL PERM ` "` Subtotal: 2 _ , Suprv. Electrician signature, required: ' Plan review (25% of permit fee): Print name. g ,N1 Dom( S E i .� Date y 14 I ( State surcharge (12% of permit fee): 7, TOTAL PERMIT FEE : 7 t '3 Authorized si ature: � .- y / . .1 g , `� --,, ._ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. P rint name .-3 Date 4 0- i t ' * Number of inspections allowed per permit • 1 \BuddmgWerm ts\ELC- PermitApp doe 07/01/10 4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures ��� FOR OFFICE USE ONLY n I N 'r 13125 SW Hall Blvd., of Tigard � ` Received 9/7 /1 Permit No.. r/57o'0//- 00/5.3 Tigard,OR , ,OR 9 ���` Pl Review / - Phone. 503.718 2439 Fax: 503 598. 96f Date /By. Other Permit No T 1GARD Inspection Line: 503.639 s` ♦G`' t Date Ready /By Juns See Page 2 for Internet. www.tigard -or gov ®i Al � No t i fied/Method' Supplemental Information TYPE OF WORK riVt ��691 7 FEE* SCHEDULE ID New construction ❑ Droll C) 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 0. 1.0/ SFR (I) bath 312 70 y i 1 - and 2- family dwelling ❑ Commercial /indusW ( SFR (2) bath 437.78 1=1 Accessory building ❑ Multi - family oY�l " "' (3) bath 500 32 CL . \C)83 Each additional bath/kitchen 25 02 ❑ Master builder ❑ Other: kA Fire sprinkler ( , sq ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: _ Job site address: '4(0 cW J' 0 f l _ Catch basin or area drain 18 76 City/State /ZIP: "mama( ( "72-2-7' � Fo ma ch o l e trench drain 18 76 f � a / ex Footing drain (no Ilnear ft.: _) Page e 2 Suite/bldg. /apt. no.: — I Project name: �_ Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18 76 Rain drain connector 18 76 Sanitary sewer (no. linear ft ) Page 2 Storm sewer (no linear ft : ) Page 2 Water service (no. linear ft . ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ADP _ Clothes washer — �LL ioCATE I 25.02 2.15,,,02.-- /7 0 - 'r u /1+ 3 ' t /Gilifival- Dishwasher 25.02 Drinking fountain 25.02 g eetr6- - t!s¢yr /f r t-f-4 --7$, nr I Ejectors /sump 25.02 p r PROPERTY OWNER J ❑ TENANT Expansion tank 12.51 Name: G 4 A a� - eo��/ Fixture /sewer cap 25.02 , e 11 51J Floor disposal sink/hub 25 02 Address: t �A Garbage ge dispsposal 25 02 City /State /ZIP: 1PM �Z � Hose bib 25 02 Phone: (g0"5 ; — V �I Z� C r Fax: ( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02 Business name: �43 7 Ca�.r�fayfartinl p I N/ Medical gas (value • $ ) Page 2 Primer 12.51 Contact name: J3_1. v�a, /� Roof drain (commercial) 12 51 /3--m.- %,,,, %,,,, Address: / seF ��+ -Ia GT • Sink/basin/lavatory SATE ( 25.02 Zia; O2—• City /State /ZIP: 740.4-P49 mt . Q7 2--7-f Solar units (potable water) 62 54 Phone: ( j3) tit) 7. - ci, 6sv, Fax: : ( ) Tub /shower /shower pan 12 51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR � Water heater 37.52 r Business name: eNz_+ YS i2KD � 4 SO L. L, TI oN S . Water piping/DWV 56 29 Address: attpaP A Other 25 02 City /State /ZIP: ro2f,� a,e0A., be-- ?7 Subtotal 4 - ,0 .40 ( S05) 7 4/33 Minimum permit fee $72 50 2' 46 Phone: � Fax: ( ) CCB Lie.: lie . ` _g mbing Lic. no.: 4635 Plan review (25% of permit fee) State surcharge (12% of permit fee) f5, '70 g C`` TOTAL PERMIT FEE Authorized signature: �� �(r Print name: ,,, _ —o Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn -County Building Industry Service Board I \Butlding\Permns\PLMU- PermiApp doc 10/01/09 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169 69 Sewer - 1st 100' 62.54 3,601 to 7,200 $233 20 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 &Ram Dram - 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) for review is required or an of the following. Performed: Capped Added Relocate Q any g• Baptistry/Font Please check all that apply Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink • - 2" Submit 2 sets of plans with any of the above. -3" -4" Isometric or Riser Diagram Car Wash Dram ❑ 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 Smk/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 • Mechanical Permit Application -. �� Received FOR OFFICE USE ONLY . o / LT City of Tigard j Date/By. Permit No J OQI6 ., 13125 SW Hall Blvd., Tigard,OR 97223 av Plan Review 1 2 ' ' Phone: 503 718.2439 Fax. 503 598.1960 1 i Vi� ` Date/By Other Permit TI GA R D Inspection Line: 503.639.4175 r, Date Ready/By Juris a See Page 2 for ' Internet: www.tigard - gov O �� �G A I � -Notified/Method. Supplemental Information CO TYPE OF WORK 51/401- N COMMERCIAL FEE* SCHEDULE — USE CHECKLIST , Mechanical permit fees* are based on the value of the work ❑ New construction � performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition `u Other: '\ mechanical materi als, equipment, labor, overhead, and profit. i `��1 Value: $ CATEGORY OF CONSTRUCTION s �J o iNi6 N RESIDENTIAL EQUIPMENT / SYSTEMS FEES* g- 1 - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessor 1 1510 For special information use checklist. Multi family 0 Master builder ❑ otG� Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATI0 VD\ Heating/cooling: A t / 1 � -n I Air conditioning Job site address: ` 7 k �7 Std 6�'r7r fT714, .5-r , (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts /vents) 46 75 City /State /ZIP: , . n 1 0 77 - ? N� �" / 9 Z- Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61 06 Cross street/directions to job site: Duct work 3 23 32 111. 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: Lot no.: Flue /vent for any of above 23.32 Other. 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 x'14 ^J ^ a8 u-J MA Gas fireplace 33 39 f _ ` Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23 32 Wood/pellet stove 33 39 Wood fireplace /insert 23 32 Chimney /liner /flue /vent 23.32 t o PROPERTY OWNER ❑ TENANT Other: 23 32 Name: 64,....6 i 4 Z3,71,y,el Environmental exhaust and ventilation: Address: 719 C/ 7 5' 4-$.4 _9 Range hood /other kitchen equipment 33 39 City /State /ZIP: •-- rz c am, 9 72,2...'. Clothes dryer exhaust 1 33 39 .V7,: Single -duct exhaust (bathrooms, Phone: (5 „'p7 - 492 Fax: ( ) toilet compartments, utility rooms) i 23 32 2...? 7 .2..... X APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: 6 ei r t _ fry 4 �, o , ,.., Other. 23.32 Fuel piping: Contact name: 1.6(t $14.15 for first four; $4.03 for each additional Address: /s S.S 5 sr Cr Furnace, etc Gas heat pump City /State /ZIP: "7Z , e1F--. 972- 2Y Wall /suspended/unit heater , Phone: (S1p7) il0? -q 4 V.. Fax::( ) Water heater Fireplace E- mail:g , ea..-r.54%44 n cc ' Grdc5T N . om( Range • CONTRACTOR Barbecue rp „0, L i �� Clothes dryer (gas) Business name: f ^� f rC Other. Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal 1 2,67 Phone: ( ) Fax: ( ) Minimum permit fee ($90 00) Plan review (25% of permit fee) _ CCB lie.: State surcharge (12% of permit fee) ( • -C TOTAL PI FEE a Authorized signature: % This permit application expires if a permit ermit is not obtained wit in 180 migagiskiv q days after it has been accepted as complete. Print name: 7 >4 4 — O Date: ( n * Fee methodology set by Tn- County Building Industry Service Board I \ Building \Permits\MEC- PermitApp.doc 09/09/10 440 ' 617T 11/02 /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 Building Division • Development Code Provision Review TI:cAR° Residential Projects Building Permit No: � /DT AO { —6015 CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ,4 Routed Plans: Original Plan Submittal Date: 6 ? / f// 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 LEA at 503 -718 ( or @tigard- or.gov) Lapl Use Case No. r Name I Al V 1� ' � (20 ® Setbacks: Front I S Rear / Side Street Side / 0 Garage N a Maximum Building Height Actual Building Height P Clearance d Easements no Sensitive Lands Type: I k Notes: Original Plan: Approved .❑ Not Approved ❑ Date: q (t It( Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) Actual Slope: Notes: Original Plan: Approved dd Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) i!( Street Trees Protected Trees Notes: Original Plan: Approved / Not Approved ❑ Date: WO Revision 1: Approved ❑ Not Approved ❑ Date: y 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 4 No ❑ Date Routed to Building: .# /i t Page 2 of 2 1 - , . , I I , . 1 I I i . 1 1 1 1 , mffil 1 1 , . 1 111 I I Z , , . 1 • , L Z I ___, („---, III 1 it , D i 1 1 = 1 [ 11 I I (Ln I 1 I „ , 1 , 1 I I !....._—.. „....-.-....----. 0 0 , ,,,_,,., 47 * ofg aL. 1, 1 7:7-1-74% . e. Its FarP7-1 r i l I 20°15' trF I-6144e- (5 2 (4piri cerea- C. I :6-4-727,t Weli-i.A. \ I \ . --- , SW ASHFORD ST 7947 0 e__ ? 7 3-4 )-f kyr 0, SITE PLAN Cr"11 c) tz (9