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Permit r -' - ' CITY OF TIGARD MASTER PERMIT � ' � COMMUNITY DEVELOPMENT Permit MST2009-00146 ,. ,' Date Issued: 08/04/2009 TTGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DD00431 Jurisdiction: Tigard Site address: 10770 SW FAIRHAVEN WAY Subdivision: Lot: 0 Project: Hergert Project Description: Add 680 square foot addition, and interior remodel. BUILDING Floor Areas Required Setbacks Required Stories. 1 Bedrooms: 2 First 680 sf Basement: 0 sf Left: 0 Parking Spaces. 0 Height' 11 Bathrooms 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right. 0 Detectors: Yes Total. sf Value: $77,326.00 Rear: 0 PLUMBING Sinks: 0 Water Closets. 2 Washing Mach: 0 Laundry Trays' 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 5 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers 3 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains. 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning Y Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn > =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! 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 8 Stereo: N HVAC N Security Alarm: N Vaccuum System: N Garage Opener: N All Other N Other Description: Ecompasing N BUILDING INFO • Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) HERGERT, AARON C & HERGERT, AMY R, 10770 SW FAIRHAVEN WAY TIGARD, OR 97223 PHONE PHONE. FAX: Total Fees: $2,429.11 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and - II 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, o work suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce;,-: , • .se ru . are set forth in OAR 952 - 001- 0010'hrough OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 50 : '.99 0 -100,33, 344. I ( Issued By: illW IA I. 1 ... ► A !I A Permittee Signature: " BuildinE Permit Application R ees d e tial , > r , - N , 4I ` 'It , • RECEN ED t its r ! 4 ; ,. , ' / F OR OFFICEtII O NLY , City of Tigard o;�eiB}4, -- Date Permit No . �n S 2039. ltU( 13125 SW Hall Blvd., Tigard, OR 97223 Q Plan Rev iew ; , V(`J` � Q . • 20 9 Other Permit: - Ph one: 5 03.639.4171 Fax 503.598.196L B �M I 6� TIGARD Inspection Line: 503.639.4175 Date Ready /By: ® Q ( q ins: 0 See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD 4 1 'n T t ( ' Supplemental Information 1 $ ) Y PE w„ p �1 VLI -. .; � SO � � = T �`* � �.... REQt7TIAE - - = 6AM1 ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Egi Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ;w -- _ -,„, _ , +.-, 1 . ,- „�:, �• work indicated on this a 2 t 'l; '�I'EGORYe Y .I' r ' i RT X'= V , ; 5 : — — application. �. °; F - x, _ � :�,� x =�: �3 �1 .y,,C. � a S . 2L , G ION . � ��;: ; =�F� �:.,� - ' Valuation: S R C cgr 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: a ❑ Master builder El Other: Number of bathrooms: a z; ;; . �` t ql. SIT = S TIO:- - ) RVCAI I O N M"E( CATI / Total number of floors: ;':a 5s � - -� � -gi ' .,.,...:�: • ...'��. �ua �;. >'.. Job site address: 10" 10 50 FA i s4 AV g.t.f New dwelling area: OO square feet City /State /ZIP: '"r; t (k� 0 R q---0_,-.3 Garage /carport area: ------ square feet Suite/bldg. /apt. no.: Project name: Covered porch area: - ' square feet Cross street/directions to job site: J k rK i ,,S . F- - A t i-A. t T r J 5r Deck area: ..._—.— square feet Xp t p. Rik V IA) , I Other structure area: square feet : ' .l D D a'' r i , ..N. I ' ,, .... ... I = t-t 'SE � GII3 G Z U'CS T �, : •. :a . an .x a, , , t ... ...._. .. ,i;�:a�; ,>,: Subdivision: ' -p. t KN■VErb Cov 2T Lot no.: — 1 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 f- 3,s " �k°' fix; -' ",,;•.x .,. ,, ::. 4 'f ;:,,. t - MDESt ; RIC'TIQ\ Q[' i t 1 ;' U RIC :;': ',. work indicated on this application. �. , ,..� .. <... Ham , . .. :__,?.. - _ -- .»a�swvt s = - „ ,..sue �•w�•..._- .' ��� - DD tT10 rJ OF NA- r rET C3CIN -ao.M + Bose"v1 Valuation: S A k7-1OA o f S DI 6 ' DROD + S � CO1JD Q J . i . Existing building area: square feet New building area: square feet '(� n OLV E-R =" ; ' :. L „, TE, „'`,1-- amber of stories: Name: p. + P Mo ,- - gc R Type of construction: Address: 10• b 5 t41 A t-Wa y E-0 r pow I 1 Occupancy groups: City /State /ZIP: - i ktvA - 4( I 0 2 9 Existing: Phone: (5b'3) 4,-- --q5- $ el Fax: ( ) I New: 4/C ' -x. '- :; .., » -..,; -`-. .. .:::.. ;“ .:'•F; `• :: ;: •xs ... . .�- .- . kt7'' ..,,..',:. ii.P,'' „w r<fAC7? . PERSON �s�:v.:,a, 3 ' . :. � ...;. , ; :��� 6,., ::; . - :'' ,.TIC t . ,- Business name: $ A 't P (! `r r ot.....)N 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: Phone: ( . ) Fax: : ( ) E -mail: I _ N. _r 11g .,. (IN'IRACT -OR` .... v Business name: Wiz - " BL UILDtNG PERM' 1T -FEES* -- _M I l 1 .:ri,� fe Address: e) U3 � �i ', i ( ten 44r,ftn, ee eeh kki i u.r City/State /ZIP: Structural plan review fee (or deposit): Li 1.3 . C t S Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB tic.: Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained ' , within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board. I:ABuilding \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB) L8 91B9 Mechanical Permit Application, FOR OFFICE USE ONLY .,... � V L a Eli City of Tigard Da Y �1 13125 SW Hall Blvd., Tigard, OR 97223 i Ian Re Permit No.: !1 jr 0�� ,� /r Phone: 503.639.4171 Fax: 503.598.1960 JUL 2 9 20 ateBy: Other Permit: Inspection Line: 503 l uris: PI See Page 2 for Internet: www.ti ard -or. ov CITY OF TIGA I ate ed /Met y: g g g otified/Method: Supplemental Information RUII DING DIVIS 1 TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction 10 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Z 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling • ` , `` Air conditioning or heat pump y Job site address: i 01 d 5' ' l 12 13, 1f W (requires site plan showing placement) 1 14.00 City /State /ZIP: -- TI L , b ) f._ cri2 :2 3 Furnace 100,000 BTU (ducts/vents) 14.00 t Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: AO t cl O fJ Gas heat pump _ 14.00 Cross street/directions to job site: v t Rh1 J L� 5 - c - . Duct work 1 10.00 Hydronic hot water system 14.00 EA-1. g-khP y vhPrI \ Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: i2 J � Co J 2T Lot no.: '—( Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: k utyr il_c_ aS kO3'pb 00 t Other fuel appliances DESCRIPTION OF WORK Water heater 1 10.00 Gas fireplace 10.00 0 vno i ©F 'DJ C.70.0 0 a IL Flue vent for water heater or gas / L IJ t Cr fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ® PROPERTY OWNER Chimney /liner /flue /vent 10.00 ❑ TENANT Other: 10.00 Name: y _f I '--et, 6?. -- Environmental exhaust and ventilation 5 f Range hood /other kitchen Address: I v�Z 0 v N R i/L � � "t equipment 1 0.00 City /State /ZIP:` - k L., A-2 (' 1 O R. T - 'L'3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (1)3) (0-O —CIS 0 ) Fax: ( ) toilet compartments, utility rooms) _2— 6.80 Z APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Gik_,A,k t .o Pk E Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City /State /ZIP: Wall /suspended/unit heater t Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR . Barbecue Business name: -,--n... E ts Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal ;5; .c Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 77, Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) ,,7 TOTAL PERMIT FEE f1 I r 2- 0 This permit application expires if a permit is not obtained within 180 Authorized signature. - days after it has been accepted as complete. Print name: J t-t j ... Date: 1 _ ( )/ d 9 * Fee methodology set by Tri- County Building Industry Service Board I: \Building\Permits\MEC- PermitApp doc 01/19/07 440 -4617T (11/02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit 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 t4..N rte: Electrical Permit Application FOR OFFICE USE ONLY En City of Tigard ®� V �Ji� JUL 2 9 2009 Date/By: No.: �5 j� _ �Z� yk 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TiGARD Date/BY: Other Permit: gee Inspection Line: 503.639.4175 BUILDING t-rING Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov lI ; . Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural El I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: \o r10 G Fp,- SRv -{ C.-7\P) WPC 1more. occupancy. ❑ Six ix or or more more residential units. 0 Recreational vehicle parks. q�2 ❑ Health -care facilities. ❑ Supply voltage for more than City/State /ZIP: ,') b A fl I 0 23 ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: 1J p tT\ 0 N ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: c.„/N (2..,t VG ` ,-TD Description I Qty. I Fee. I Total I * New residential single- or multi - family dwelling unit. -, 2t J e Includes attached garage. _ Subdivision: �'� RSA J coV R. - i . Lot no.: 1,000 sq. ft. or less 145.15 4 no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map/parcel a S 1 031)-0 b043 � Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 )�,� Limited energy, multi - family 04 EPA' L 0 t I 4-p D via o 13 t1,3 I R. t 0 L� - 1 - 3`b residential (with above sq. ft.) 75.00 2 ( Services or feeders installation, alteration, and/or relocation 3E co r c.T t ,. O C os v.-1--) /`o-i. 6e 5 ILF 200 amps or less 80.30 2 • ,gr, PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 (\ M a 401 amps to 600 amps 160.60 2 Name: i� v� A. 601 amps to 1,000 amps 240.60 2 Address: No-N-1.113 St.J ctA( Ke r p..Je - d („ilit• Over 1,000 amps or volts 454.65 2 City/State /ZIP: I Og_ en .-- Temporary services or feeders installation, alteration, and /or ���D tit t relocation Phone: ( 733) (rio �45Is-s9 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 o xchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 \ Branch circuits - new, alteration, or extension, per panel Owner signature: Date: -- /—Z$ --CPI A. Fee for branch circuits with a APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: c$ " -E if\ iSt7 J C B. Fee for branch circuits Contact name: without service or feeder fee, j 46.85 R1tCi8 2 first branch circuit Address: Each add'l branch circuit '3 6.65 [1,16 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: lO g E 0 tom^ E energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 1 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: (, pc) Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 0Z Authorized signatur TOTAL PERMIT FEE: 74 , 8 2 This permit application expires if a permit is not obtained within 180 Print name: Pk-tovs.R a r ..1 9._ V L�2 Date: — 7 (7..t O () days after it has been accepted as complete. ' Number of inspections allowed per permit. 1:\Building\Permits\ELC- PermitApp dos 05/23/06 440- 4615T(11 /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* • ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations P\Building\Permits\ELC- PermitApp.doc 03/23/06 Plumbing Permit Application Building Fixtures l• A-- FOR' OFFICE USE ONLY III City of Tigard Received Permit No.: fr54 - 02� y!... pe P V 13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 9 2009 y : _ : Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date /By. Other Permit No.: Inspection Line: 503.639.4175 CITY OF TIGAR I Date Read /B Juris Ell See Page 2 for TIGARD Internet: www.tigard or.gov o[ified/Method: Supplemental Information �JI! �JIP.DlVIS!�� ' 'TYPE' OF WORK - FEE* SCHEDULE ❑ New construction El Demolition For special information use checklist Description Qty. Ea. Total i ?( Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) • . CATEGORY OF CONSTRUCTION ' , SFR (1) bath 249.20 g 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ID Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 . ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND` LOCATION Site utilities Job site address: `D ' L tc c K t kp r y i„) Catch basin or area drain 16.60 City /State /ZIP: 'T A.(Zi) t 0 12 9--I 2Z`3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: S2-) (4 1 Page 2 '55 - l Manufactured home utilities 110.00 Cross street/directions to job site: c' A t 4 S �,p �� l Manholes 16.60 Ff'r 1 a ti.a -1/ G. i/JW"� �I"� Q: O l Li Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _ ) Page 2 Storm sewer (no. linear ft.: _ ) Page 2 Subdivision: - e...0..43,‘,/ �J L�✓ p.:-r- , Lot no.: "7 Water service (no. linear ft.: _ ) Page 2 X LOT . ] S t 03'bb 66 y3 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION_ OF WORK Backflow preventer Page 2 DD 1' DF y^w/1,S"�' -(Z $m12.00"-t- gt\-- -gzQM Backwater valve 16.60 r O U 1r E'X t $''fl tJ b g €NThThi2Do !' 41- X Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 4 PROPERTY OWNER ' , 1 , ` T : ❑ TENANT - Ejectors /sump 16.60 Name: ti - \ -- y� -A R. u 7 Expansion tank 16.60 Address: 1 O - 10 rj: Pl. A epi IyJ*"\ Fixture /sewer cap 16.60 City/State /ZIP: -‘ () ( Vg... `1,'Z'2.3 Floor drain/floor sink/hub 16.60 Phone: ( t3) Co 10- gs-a Fax: ( ) Garbage disposal 16.60 [APPLICANT Hose bib 1 16.60 (b, 60 " ❑ CONTACT PERSON' Ice maker 16.60 Business name: t) iN,1..■ O TE Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 2 fx.g -rh.1 � 5 16.60 �j j ,� Tub /shower /shower pan - Tv v. 3 16.60 A`i'EO E -mail: Urinal (`A E 16.60 CO Water closet - G. 16.60 '' 2O • Business name: -^- tz G 0P-- V � Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50.1 37 e Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.2 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) •yg ,5c State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE 5 Print name: rJ l 1 Rt,leYt Date: This permit application expires if a permit is not obtained within ` 1 180 days after it has been accepted as complete. --- 24.4,, ` I *Fee methodology set by Tri- County Building Industry Service Board. I:\Building \Permits \PLMF- PermitApp doc 12/27/06 440- 4616T( I 0 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: SiteLLlJ Fee lea) Total Sq uare "Footage: .Permit Fee Footing drain - 1s' 100' 55.00 0 to 2,000 $115 00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160 00 3,601 to 7,200 $220 00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation:'. "' , a ° Permit: F'ee:. 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 ' Fee ( ea) �Total additional $100.00 or fraction thereof, to and fixture, or. Item a `: 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 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Commercial Fixture Work: ,,$Ian itevievi -for P,lumlb ng;Instahations 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 * . ❑ Any new commercial building with water service 2" and - QuautitY by (Fixture) WorkPerfornied greater, except systems designed and stamped by licensed Fixture ".Typei , -, Replace engineer. Previous. Capped ❑ 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 Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" -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: 1 :\ Building \Permits\PLM- PermitApp.doc 12/27/06 This form'is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. 7 BUILDING DIVISION p. TIGARD TRANSMITTAL LETTER a TO: In DATE RECEIVED: DEPT: BUILDING DIVISION RECEVED JUL 13 2009 FROM: ,�� = _i b CITY OF TIGARD COMPANY: 1n .� �j D CO k .1..1.2. BUILDING DIVISION PHONE: fb- (g — 6 \FD \ By:b RE: ,� V 72 h ss I v� (Permit/Case Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: _': D x ''i'` es° r "i "' i� -- - ,Cop es:� 3: _ c _,pt o'n: ., : ...> . .. 'C,opies =�Descriptione.` . , ,,:: , 7 - J7 -, :,:;,„„r,: , .;.: . Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and /or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. k Other (explain): 1(Z__4 v i S-pe' jr-k. C.1 Li I (19) �) .ecc Ch REMARKS: ., : . ; :V . - . FOR'OFFICE' SE ONLY �. Routed to Permit Techn Date: a a�l t Initials l A 2 i w Fees Due: ❑ Yes io Fee Description: Amount Due: : 9; ;:,-?,. '- - ^,,,--, :. °R ' - '.:.i',' $ r„ . .''' s i a s ' "`', $ �� -2 .' - ' ' e L - c� °�p #`•.� _ -_;� .`.ry'-LY'Y'�;a,al,�;'�-c ty ."_ ' . ,4 :c _3 .t ;. s' , ,- ,. : t` : ;- i4. $ i ti $ - i, y � 4 y _ .p y,^ c -- $ Special Instructions: _ Reprint Permit (per,PE): n Yes ❑ No ❑ Done Applicant Notified: Date: Initials: l: \Building\ Forms \TransmittalLetter- Revisions.doc 4/4/07 • 0 „ „, Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true•and accurate. � ti 1 : I Print N a : o :1 . nt ,.,„..,.., .-7 9•(4 -09 .......„..., - Si• a re o ' ermit Applicant Date Permit #: MSTZO0 • c i (f (p of • Address: 10 -Cpl ` - h oc ki rz r .w,i+nr cc,r C) i2 9,72_23 , ;,.:.. Q // ' ,,; rte! Issued by: Date: V - • CD9 E t • This Copy for Permit Offices RECEIVED . s JUL 0 9 2009 CITY OF TIGARD BUILDING DIVISION Elev +1' N 89 53' 35" E 140' Elev +1' l l \ \\:)"..,....\ 5' c ■ 0 S X/I t 1 N 0 4: : : )) ) 4 " - - . / : ,...._ A i ‘ -. ' . ,. ' 1 : ;::: '1 . _. I s � - I \ ��- , — 1 , \ I ' \ \ \5 A ' I I I II 1 en \ t i I _ __ - 1, I I _ -- \ \ 1 `\ I ,/, 11 I • ,,/\ \ , I I /, ti II i , I J' \ 1 ' ___ -, - - -- �`` i i I / \r \ , \ '--- - - - - - - - - - -' - - - ... _ I \ - \ - :b °\ Rain Drain and Perimeter Drain . \ to connect to Existing I ■ \\*\\ — ----- ----------------- - - - - ' ■ ■ ' o \ N \ l i I \ I \ A _ o - - - -- N 89° 53' 35" E 32.35' Elev 0 ■ \ , - -�� 4 g • $ 5 Elev o Fairhaven Way 2. - i . — 'R \ vnv s - _ Boundry • Setback ..,,('— EROS 1o l;ontractor Location Date Scale Plan No. Draftsman Gerry Aleshevich I ; 10770 Fairhaven Way 7/2/09 1" = 16' 10770 Fairhaven Way 505-393-0271 .r, CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: - 2C D OO(tn CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: _ _ Street Trees: ❑ Approved ❑ Not Approved PLANNING DIVISION: Protected T 0 Approved ❑ Not Approved Required Setba ks: Approved ❑ Not Approved By: Date: V/ S /B1 Side: __5-._ Stfeet Side: ?o Notes: Front. . Garage: _ Rear: : rig Ok Visual Clearance: 51 Approved ❑ Not Approved //ip ,k7 /7,4 Ok - Maximum Building Height feet CWS Servi • Provider Letter Required: ❑ Yes g1. N • 0 Re •eived i� By . Date: •? it ' �09 _ ENGINEERING DEPARTMENT: Actual Slope:_,Z_% :1 Approved ❑ Not Approved Site Plan: ::4 Approved ❑ Not Approved By: �f/��i / ../ Date: 7 -/1,4 Notes: