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Permit I� ll • CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009 -00182 fl Date Issued: 10/01/2009 iGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112CCO3700 Jurisdiction: Tigard Site address: 8020 SW CHURCHILL CT Subdivision: Lot: 0 Project: Elliott Project Description: Relocate kitchen to NW corner of first floor. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms' 0 First: 0 sf Basement: 0 sf Left' 0 Parking Spaces: 0 Height 0 Bathrooms' 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value $55,000.00 Rear: 0 PLUMBING Sinks: 2 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) ELLIOTT, RANDY & MARSHA IRWN RENOVATIONS 8020 SW CHURCHILL CT 9929 NE CAMPAIGN ST TIGARD, OR 97224 Portland, OR 97220 PHONE: 503 - 639 -1093 PHONE: 503- 752 -8409 FAX: Total Fees: $1,266.15 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344. Issued By: � - talk , I � ( ). I I J Permittee Signature: 1 T Building Permit ApplicAtion Residential NOISIAIO JNI01I(18 ObltlJll 0 Iv-10 Q a FOIZ OFFICE USE ONLY Permit No.: W / O�/ �1O Q p� yi Q City of Tigard DateB / 'd7 li 0 q 13125 SW Hall Blvd., Tigard, OR 97223anO7 5 I c os. Plan Review s tee• Phone: 503.639.4171 Fax: 503.598.19 DateB : 1 r y� Other Permit: Line: TI G A k . D Inspection L 503.639.4175 CJ3/\I333'd Ready/Hy: /s I , mns: ®See Page 2 for Internet: Line: gard- or.gov Dat R V 1 ' V Supplemental Informat TYPE OF 'WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ .� 1- and 2- family dwelling ❑ Commercial /industrial 5 l ac 0 it Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: • JOB SITE INFORMATION AND LOCATION ' Total number of floors: . Job site address: /OW SO C11(.1'0'4 t G+. New dwelling area: square feet City /State /ZIP: ' f j JJ (AA 0� '1727)- Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: el G Covered porch area: square feet '4%) Cross street/directions to job site: Deck area: square feet i Other structure area: square feet 1 Subdivision: REQUIRED DATA: COMMERCIAL -USE CHECKLIST ( 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�verhead, and the profit for the DESCRIPTION OF WORK, work indicated on this application. ,l ee,Lt.,t. e.- i� j _ ` „A- '4D 14� r /� - - _ f k Valuation: $ I 1� ° 1(/� " CA ✓Yl R.N. o l C� ST Existing building area: square feet _ New building area: square feet k Lvr ,/ PROPERTY OWNER ' ❑ TENANT Number of stories: Z� Name: ,ne(,.n / ..y- ► • w, r c& 61F Type of construction: Address: V0 tfig SVJ CAufa4 1 OF Occupancy groups: City /State /ZIP: ' I V R 'I , /2-4 Existing: \ . ' Phone: (SC) ‘5) (5 1 — I 0 3 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT .PERSON NOTICE. Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons • apply. I t Phone: ( ) Fax: : ( ) E -mail: CONTRACTOR • 2 Business name: I e tAriv. Re v,dJ cOla ri S BUILDING PERMIT FEES* N Address: 9t2 1 r[t2 Coxyi St, (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: Po fIF (aM -d 0 9, 20 FLS plan review fee (if applicable): Phone: ( S03) 1 Si- gy a 9 Fax: ( ) a.. CCB lie.: 1 I LI 1 LS a - a 0 . IV Total fees due upon application: Amount received: 355, Authorized signature: �--� /.�� ---- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 0 r, ice^ Date: 41 f 7 l� 1 * Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) T U • • Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE US ONLY City of Tigard Received Permit No.: • 11 Date /By: q 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: C Phone: 503.639.4171 Fax: 503.598.1960' ❑ Electrical ❑ Plumbing ❑Mechanical 24- Hour Inspection Line: 503.639.4175 I I GA RD Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes 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: . Cl ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. El ❑ ❑ 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- El El ❑ r. otection, etc. 10 3 mplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ I ding codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 1 I Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ , 4 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. i ` ' 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size El El �J �) and location. _ C[3..) Floor plan's. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ CI t� t�° 1:: - 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. -- w. C.. l-qt a,4 4 • m � �5 () ')Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. CI CI CI y tip Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building_e vel N. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ El prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists El El ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. El El ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the .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. ❑ Cl ❑ 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, ❑ . El ❑ �1 and protection measures must be drawn to scale and must include the project arborist's signature of approval. ro ' 90 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ CI CI N (�i /' including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP -RES- PermitApp.doc 03/21/06 440- 4613T(11 /02 /COM/WEB) • Mechanical Permit Atppli �Q JNicnn9 . .FO OFFICE USE ONLY City of Tigard Q8V911 Received N i Permto.: e ° 13125 SW Hall Blvd., Tigard, OR 97223 7 Date/By: �� �Q 8: II Phone: 503.639.4171 Fax: 503.598gOR 9 T J S l Review Date/By. Other Permit. TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov 3A13,238 Notified Method. Supplemental Information . �,._„ .. � :� .,'': xw"°":'i:F, = ;: R- . .b::c. - •; . .k�€ %;.t?^ :wy,mz F„ � ;� � �`�aau�aa.:a:- ., ;r- ,.>.m, �,x,� ,, .^ :, :"1TrYPE F- .: W ..:r s, s CHED , ,. �. ,'� ...:. �� � O ; .,CORK. ;: w`�`:`,,u" ( �, �,� C0 IVIME IiCIAL�EE ULE �US>J ^ . CHE CKI,TST � ,. _:�»` i� .^ .k,'k"�- .a :-. ` d."Y``C �:.; A ?s�*.".$'3a- ,>r.A "t'G.. cas� , .a� . ..:. � ., a. .r.. Y� o-,r�` , ads � ., aw.'nbn .. +�kvua:.z :vwx, �'RK.- '92«'� � .,. � w'%�-$ - °w��M - rsr: n'��. Mechanical permit fees* are based on the value of the work ❑ New construction Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. `, "_ ':" ;.:e, v.,44A.4, .''- :�siau? = r,:.re _,:,: v44..; 4�,: > "....,; tip., ::.r#,ra,. :.��;��,�:.. � =��` ���y.,<<�;:; �,r } .. .� Value: r CATEGORY O ,MP :In , ` - , :v"��. .�...-.. <t�;,.�. ,�:���.ad.� � >a��.�...:,A,� : ���.�,,,4t�..�.,> x „�„ �:�.�`"r.�s� a��4+'� �,�;'�RES TrIAL �Ull'MEN��SY �S F � a.<. '" -�,a�� ., � z,�v sue ., � s � � � ,� �� [2.<- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building " For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total a;::aY' "`"R'w."';+,. `` .�- ,�:�:;: +: c=rrr;..: - ,• .. »a..xryy °�::,::.:..,¢ays•,,..r. ...:=t..,;;5;^^'_ . ''v ' At OB FORI N_ D LOCA`TIO - x xr Heating/cooling � � r! - _ - Air conditioning heat pump Job site address: 80 � S � .! t 1 � � (requires site plan showing placement) 14.00 City /State /ZIP: '.-T-( .c � � ce OK q' '2 Vi Furnace 100,000 BTU (ducts /vents) 14.00 J Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: ifi lJ //l Gas heat pump 14.00 Cross street/directions to job site: Duct work I 10.00 10 - Hydronic hot water system 14.00 Residential boiler (radiator or . hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. . 14.00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances m,,, ,: "- " . ,.,.., 7 ' * , :.: z x�.,: ,,,. .:; rr . _ . ; yr:.•. ;... ,, .' ; Water heater 10.00 DE SCRI :P O F W el a =+'.�.^�%���„''�'`��. :. "+� � ,,.,` = ��n, z=`•: ,. �,.- .�.z�... «sac �srs.�"�.a <a 04f .,., ZE'4eV* Gas fireplace 10.00 lZdee / a� -- Ad� ckr, r 2 - t\- -a- Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 r; . - = € t:, r•,..,.,:- e;:x , , ; rK.4,, : fir.," ;�:.. , ,. < r,: .1 Chimney/liner/flue/vent 10.00 D PRO"J�ERTY ® },''NER ,'; � ' � 0 TEISANT a �,4, rzb ie , C .. -.. ants - r ��..r<.,�..��, ate,. � "� -, . �a�,r' s:..� :...., W ��a ��.0 � ..._ -�v" Other: 10.00 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment - 1 10.00 ��' City /State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ;sk =_ €- 7.,. ;' £, Attic/crawlspace fans 10.00 Vii° . APPLICANT. 0:4. tW ' . ,.;,.. . . , - :.CO 1 4 ` ?4 I PFsRSON a , P Other: 10.00 Business name: 1 f 0 v.4 , ZNItit!4rU A1. Fuel piping Contact name: .s 0 CI ( (2_ W) il $5.40 for first four; $1.00 for each additional Furnace, etc. Address: � F (. , S . ./ Gas heat pump City /State /ZIP: PO r•44 6 PP // 7 % L Wall /suspended/unit heater • ( ) 7 ' ? ty Phone: �. 1 O a Fax: : ( ) Water heater Fireplace E -mail: Range ri1 .de a ` , 1 g a - Co1 s b ;il x4 Z Barbecue Business name: Clothes dryer (gas) Other: Address: =n r ;R� ��a< r , .r: , *::.; ;: +t:'=.P _ , MEC HANI' GA L`P.E R,,,, , FEES u t :.,'�..- - ^.a..,',r, s�W�, :Y,a � saxa,a� =: _' � *=- r , < x;. . ,. ^ o�.l a . City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 72, �j ,0 Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) , 7 0 • TOTAL PERMIT FEE t , ZO Authorized Signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: f ,.4 Date: jj a / 0 7 Fee methodology set by Tri -County Building Industry Service Board I. \Building \Permits \MEC- PermitApp. doe 01/19/07 440 -4617T (II /02 /COM /WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Vabna><on .,. r Permte ;: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and , $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\ Building \Pennits \MEC- PermitApp.doc 01/19/07 2 Plumbing Permit Application NOISING ONIa1Ins a}V011 O A1I0 FOR OFFICE USE ONLY ' , City of Tigard Received Permit No.: I I zoO _ Oa Az : l - w 13125 SW Hall Blvd., Tigard, OR 97Rnz I d3S ` Plan Review Phone: 503.639.4171 Fax. 503.59 1960 Date /By: Other Permit No.. TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard .. Notified/Method: Supplemental Information > :'�: :�:�� : " e:c:;+a�ar' z �,, ' {{{ � $, e *. _.�? ARP Y x�S,-��`. Y '�' w ' ' `' y5 .�. a' a�U "Fit � ff���'� , 3u.`:wR ''"..=L� .ssu,".-'Lu.J. N�� .x, - 1:„ ' .. 4 u 0 Y.. � 4 - f' ,, x �5.. }? >aa..� :. E , :.. •: r- 1 , '; E , -. RK .- .w m . . a r F REE I�FD E,: tAt z� ; ; r .,` + ":i� ��:•..>e. :;= a�sk�.'�=" ��;: . �:,.':.)x'� - .. ;�i,..�.. raa.`�:a <a++- �.�^5��' ..,., :.�; �.� `�. ;; °-:su -:� �°? =s, .a' .. 3� : ,..::s?,��i,�,ttc�:� -�:�s ,=�.z; n.� .;..,: ''e� t ,'>;k�'b. '�'�%..: . M ❑ New construction ❑ Demolition For special information use checklist Description Qty. I Ea. Total Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) > %ie ..-�;3� >:„�� "_ ", °.�F.r,'a<r L:x -°: i�x�S':Ri^�e<:'.' *r_,;�. ,... 1_:. =.:z $k'" .. �'"s�. i ° : :?4T IGORS'u OF CONSTRIiJCi'IUN 5 - 4 5 °r � - :..:-,.:;.: a., ' `u, -.: .., ,.�...N..., :tu.,.- a'x o,..3,,.r. , ,., -," ..r, ,�, . _:, ..zni� SFR (1) bath 249.20 L 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: 2 *�,.. - : ._'.. ,s 1 ..-°. .:�`,,;�ri ®::vmex. .r1.';... r :. > -:.E. - t Fire sprinkler ( t1 ft.) g spr r s fr. Page s' a " x �a ' JOB S. TrE, I NFO`2MATION AND iLOCA TIONr,„x� ' s "tf, e'f:. :,„ -,,t4 .. ,, .,a „...,, 4t 0i,.o- ,,.,,,,,&6,, , . ,. .z,f1 d: =r., x, .=r, ..,.a. " . a x N3- .Si util Job site address: i 2 o Svj Ct ,✓ n ��--= Catch basin or area drain 16.60 City /State /ZIP: ' `t p --- y tTl Z 7 `-f Drywell, leach line, or trench drain 16.60 Footing drain (no. linear ft.: _) Page 2 Suite/bldg./apt. no.: J Project name: �'1(i.��'lf' Cross street/directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: ;-,;a rx:_.,�k__;.a=- .,.:: -: , °, ,- fur Absorption valve 16.60 ro t ; Y i' Z a } �, , DESCRTPTT , 9 1tR �'` . .......`v , �a', : Backflow preventer Page 2 r•x.1 d C-4.-. .`i • 0 l,v'r . y.... Backwater valve 16.60 ' Clothes washer 16.60 / ` Dishwasher r 16.60 1 �,.� -, tee <a, = ':: `'; :ME , § n ,. Drinking fountain 16.60 un ;' #, PROP,ER ,O niR . v ' r < 1 Ej ectors / sump inkin un 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal Q 16.60 1(p ,( .,.. r.� r axe,,...- Hose bib v. .,_.:, > .�� ,� [ 16.60 �(�. -- ,•.a 4 F m,.Z..:..,'` +:�", " X 71 - . 'N ,"; : 'I #' � " "j:e; �5,„ �APP.,,LTCAN f i 2 _, � , , CONTWi1GT PF,'RSON A (vO . -mss.," , s»s: , � , r , :;:w`:w -_ _� ,< a.,..' `.�, .. v.. w , . . „s a attx°�ce�'ce. z:. � .., s .. -... �.��,+.�' � r ,. Ice maker I 16.60 Business name: ( 2 vsl" B=CC is i /mi'�`J'5 Interceptor /grease trap 16.60 Contact name: 17 3 LS a. UN/ f Ai Medical gas (value: $ ) Page 2 Address: 'I i . LI / J C, ,,._ x .�g y �, S.4_ Primer 16.60 City /State /ZIP: p -�-1 �,,,,nr-t( 6 4 ' 77 2_'u3 Roof drain (commercial) 16.60 Phone: ( gip` 1'j z y6 Fax:: ( ) Sink/basin/lavatory 16.60 S3•ZD c. Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 7; ? _ Yc.'...y�:* - �. ",?' :'o�Y`sss ' :2rx " ^.§.::.;s .M�i ",ri.: - h ,`' ° .9 w,"� g s.. = . c F , .: ,_ .�.. x . :; . ' ..^.< : a�:t.. - w' +;i� ";L ^.aY - i3 "a:...: ;y „�-.,..:�., �.�,A: •.sm. +.�5 ,2`6'`sy.: "" ^a.:'F;`i , _... �.. ��^- s(`���,:i.....- ,�- ��•,:..,... ��r�. � / " � �` ����_ � ��- :::��: - > Water closet 16.60 Business name: ) L � ` ( � ecle -r f pL u pl 6/ A 6 Water heater I 16.60 Address: C! I � . r" e- H G�CF tJ! g-4 c f Other: 7,,t(0(,t%1G dLVtU t' t�. s Subtotal co, City /State /ZIP: Per 0 q'7 2- 7-:v 1 Minimum permit fee: $72.50 Phone: (5 3 'F - 3' � Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: ( 74, 4 S" } Le - bi . 11 Plumbing Lic. no.: 3- qct 3 P S Plan review (25% of permit fee) State surcharge (12% of permit fee) 1 ( , ` Authorized signature: �, .,__,..1.,,wi_ 5 f TOTAL PERMIT FEEL "L 1 , 5 Print name: &1 T ,,,,f Date: '�I1 /?'�C7 This permit application expires if a permit is not obtained within - /`" l 180 days after it has been accepted as complete. • *Fee methodology set by Tri- County Building Industry Service Board. I .\Building\Permits\PLM- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: r " 4 . � '. :tow ; °.Jr .., •xq �. f�l% _ ;3a,';: ^;�:�a �k�a^.a, <# ;�, 2^%"w -; �i'.6CF� "Al C3 Qty Feea o . I Otal S1teUt111tI .._. U ..w...._ ..�'- ..... : t^ .. a uareFoota e. ei`ililt Fee - Footing drain - 1'100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46 40 r ° ^y.agr,, ; x; f °. =:,, , m' - + t r; rfk - =4v. q uat on: ., Perm><t Fee ;, Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each .., 3 ° ;x: "' Wt 1 ee`'ea' '= Total" additional $100.00 or fraction thereof, to and F Item " Qty ,,., including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional.$ 100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Commercial Fixture Work: Are you capping, adding or replacing fixtures. If "yes", ����,w jfla�n���' 1P��5w�gl���I11Itlbin�� °TI1St�a1Ia�1OIiS���,��;, please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. '��. °I :Mrea '`�� "t-�' •;' .�uantit by fAiiire =Workt'performed g ❑ Any new commercial building � Ra � -� � � � ��- -yap( ) -,. a � _ .. Y g with water service 2" and FtztureT e` [ x �,' ":r Replage`:� g except systems designed stamped by � t � � � '� "' realer, exce t s stems desi ned and slam ed b licensed ieviouss . (3appe8.= ?A d'7ede j Extstm'g engineer. Baptistry/Font Bath - Tub /Shower ID New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool -Each Stall ❑ Medical gas and vacuum systems for health care facilities. Car Wash - Each tall ❑ Any multipurpose fire sprinkler system. Cuspidor /Water Aspirator ID Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain , � ,, ti Eye Wash �$y�90I11'Et rO'�lSelDl'cam ,. n ; Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall • Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor • Water Closet - Toilet Urinal • Other Fixtures: i \Building\Permits\PLM- PermitApp.doc 12/27/06 09/16/2009 20:55 5032554055 IRWIN PAGE 02 Electrical Permit Applicatio City of Tigard E 1 P 1 1 2D °S 1L•--- :rl STigd, OR 97223 S Phone: 503.69.4171 Fax: 503.981960 Inspection ) 503,639,4175 CITY Vr TI ' da R a dy/By- Other WI Other RerPermit, See Page 2 for Internet: wwwttgard -orgov IVISIDr s .N o tified/Method • � `.� t � NG D Supplemental Information • h 6 :. � li, t r t ' � ,. ' a`t EL � 2 ` :.. M t ,et-e . ,:.. row,- r•'��;, N'rli�• r s t li . I , �" s r .. [3 New construction s' Addition /alteration/replacement Please check all that apply (submit j sets of plans w /items checked below): © Demolition 0 lather: CI Service or feeder 400 amps or mart Ei Building over three stories. 10,000 a exceeds 10 ,� . ,,� .,, s r-e_ where the available hull current El Marinas and boatyards -+ • "" 't: L a , :� r ' : ' :1; s "' '- at `fl' i , s et 150 votts Or - ''• - .�. ='�A war. aoTa .��.a,�"tnr+�u�9aR�^ar}e�i1L r`''�7xt q� P 1]Ftoatmgbuildings. l and 2 famil d wellin less to ground, or. exceeds 14.000 0 Commercial -use agricultural y dwelling ❑ Commer ci al /industrial E Acce bu il ding amps for all other installations. buildings. ❑ Multi flimily 0 Master builder 0 Other: 0Fire ,i . � 7 i - �. *•'xrtc 1 . '7,. - �.,nrr Installation larger separately 075 derived or ' i ; jai -4 Y I , N ,F t r t * �k w t: is r. ,! r �x ❑ Emergency system. larger aeparataly dcri .d system. a'4'1U we�,i: r> . .._; - n ,rtr:s rL ..t ..::.� iyr.4:',.. " i4r a::..a 7 ..,' s .t ° . _`' El Addition of new motor load of 0"A ,. ,. .. -3 ". Job no.: Job site address: 06,4.0%.4,1\ ` { 100HP or more. ocoupaney. - ' �� $ 0 Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: , 0 a • r 0 Health -care facilities. 0 Supply voltage for more than E.\\ ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: G\` id ' 0 Service or feeder 600 amps or more, Cross street/directions to job site; Wrtrivdvn Qs,.. pa fatal • New residential s ingle- or multi- family dwelling unit. • Includes attached,garage. Subdivision: rLot no.; 1,000 sq. ft. or less MIKEIM1111111111113 Ea. add I ne 0 y or portion ill 'fax map /parcel no.: q• p o 33,40 - t � Li energy, residential '..,'. r }`I` .:.• ^.: l a , t y r,: a ra i c. r r.47-1531 : t F 1' %! with above s,. ft 75.00 R&\OCOa1rC. �i etl. f q ti Limited energy, multi - family �- `��� I h (l�1tl� t"I�OYV\ J residential (with above sq. ft.) 75.00 2 V Services or feeders Installation alteration and/or relocation .-'tad 1'OCW% 4tna... Asst s or less ' `)' : .;- ,r -r r x -set• �� x r � 200 am r r _,rr ?�. r P •60.30 2 `�° •'•o. =r Y.:e' js . : rx�st�::timr i� . FY ,a s' 1 I r �a#r i �.;i".'f _+ _ti 201 amps to 400 amps 10 ,85 5# 2 Name: 401 amps to 600 amps 160.60 MI© Address: 001 amps W 1,000 amps 1111 240,00 MN Over 1.000 amps or volts 454.65 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner Signature: Breath circuits. - new alteration or extension, . er , and Date: . A. for branch circuits with :i� a 3 s�, 1 1 imi � 7� k � s F' e�'.f'"' t7r'Y fib'"'_Tr` +�•r -� +y?x ',� I r:. xr .4;- ,4fi - ,si~ . '4 5.F • t . `_.1 'l .atVlc �.vr..,,s:...:: . �! ti.....,: 3r..0 .l above service or feeder fee, 6.65 • Business name: each branch circuit �- Wtn thafvus■loAioNS B. Fee for branch circuits Contact name: �ou �PV-a s^. without service or feeder fee, . 1 ` 46 55 �� t 5 Q first branch Circuit • Address \ \rr.L� t' � � Q t\ Each add'I branch circuit 6,65 - - �b r� J Miscellaneous (service err feeder not included) City /State/ZIP: Po t"�1�a�1. Qp a - r 2�� Each manufactured or modular 1 � - dwellin:, service and /or feeder 90.90 2 Phone; (i 2 S?„ - amp a 1 Pax:: ( ) E -mail: Reconnect only 1111 66. � � y4 . Pump or irrigation circle . 53 - © . : i' .'rF,• w ... y, � t � ...!� � '� i :: N � M r ,� sign . `R+� � .:� T ....,f'- � .,.wi'I.ti,.1.::rkR.,..�`M K 3`. ,i;��:W_.�..i; rt ot outlineiightin g 53 Business name: Q � a t[ �,` _- t 1,��.� Signal circuit(s) or limited- S I� x-`�- �Gw` � S4t Wv energy panel, alteration, or Address: 53 ('7 lAe. s4.- g n Si G extension. Describe: Page 2 City /State /ZIP: \) - - Ve6 1 Each additional inspection over allowable in an otthe above Per inspection II 1111 Phone; ( ) ( - Tei Fax: (360 ) ('A 62.50 (� L 3gS lnvcstigati0n per hour (i hr min) 62.50 c B C ectrical Lic.: C. 3t., 1 Suprv. Lic.: 5331 S Industrial plant per hour 73,75 Suprv. Electrici ignature, required: , C ?M1 i .w +. :.i ,r :.m' eli I � sa "c • • -. Subtotal; vs .( 93- Print name: dew' Date: ot . , , .. Plan review (25% of permit fee): ■r State surcharge (12% of U . Z Authorized signature: permit fee); TOTA t u e r _ -•� -- L PERMIT FEE; '- r ^'Ck3 it) L . i Print name: D ace: This permit application expires it a permit 16 not obtained -within 700 ■ • . _ ' (4.,, C ' drys .tier it ha been accepted es complete, (: �uildingtpermlul6LC- PermilApp.doc U5r'23/0 t WEn I " Numberofinspectionsallowed � la - (. (V TO/TO 39 d 0IZ110393 CNOWdIG L58E56909E TZ :60 600/2.1/60