Permit , 1
x �
CITY OF TIGARD MASTER PERMIT
ip
' a ° - COMMUNITY DEVELOPMENT Permit #: MST2009-00136
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
) Date Issued: 07/15/2009
.,i ARD 9 Parcel: 1S133DC01800
Jurisdiction:
Site address: 13245 SW FALCON RISE DR
Subdivision: Lot: 0
Project: JOHNSON
Project Description: Bedroom and bathroom addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: 1 First: sf Basement: sf Left: Parking Spaces:
Height: Bathrooms: 1 Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: Detectors: Yes
Total: sf Value: $35,000.00 Rear:
PLUMBING
Sinks' Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Catch Basins:
Lavatories: 1 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures:
Tubs /Showers: 1 Garbage Disp: Water Heaters: Water Lines: Drains:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers:
ELE Heat Pump: Y Hoods: Other Units: 2
Furn<100K: Vents: Woodstoves: Gas Outlets:
Furn > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less' 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp' 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'l Br Cir:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecom asin N
Other: N Other Description: p 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
MATTHEW JOHNSON WOODMASTER NORTHWEST INC
13245 SW FALCON RISE DR 46363 SE WILDCAT MOUNTAIN DR
TIGARD, OR 97223 SANDY, OR 97055
PHONE: 503 -524 -5090 PHONE: 503 - 668 -0443
FAX:
Total Fees: $726.10
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accorcce wi approved plans. This permit will expire if work is not started within 180 days of issua ce, or if work is suspended for more the 180
days. • TENTION: Oregon -w - •∎ires you to follow the rules adopted by the Oregon Utility NotificaiOn Center Thos rul - s al set forth in OAR
952-011-0010 through OAR 952 -: 11-0101. Y• ay obtain a copy of the rules or direct questions to OUNC by calling •3 • •$ • ; .;SS0 2' • •A
Iss -d By: 1 #
Perm ittee Signature: !� r ( t; 1 !'! / /1
V
• Building Permit Application E_st- c rykU 2 szzl) CIG . CO 2
.
. . . .
• Ite.sidential REC FR OFFICE USE ONLY .
.( EIVO ' . - - ) -
Recived
' 0 I Permit No.: ' 11111 • ,g);
13125 SW Hall Blvd., Tigard, OR 97223 JUN 1 1 2009 i t
111 I • .11 . City of Tigard -' e
- Phone: 503.639.4171 Fax: 503.598.1960 Date/B : ' ' 0 • , .. Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ......... t • ' ei See Page 2 for
CITY OF TIGARD
Internet: www.tigard-or.gov Notified/Method: e' - k ' 4 eliM Supplemental Information
BUILDING DIVISION
gm
Avy- wee.:-7';'wfl t;
,x5,:iri''' ,:A A , •.,.:.,.';%. WliikkoiX44,, :;...4
D New construction 0 Demolition Permit fees* are based on the value of the work performed.
Addition/alteration/replacement
IX D Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
Wge"a VfairdoliVartarliteeffirleM447'WWW:',AN work indicated on this application.
ke 't'a. %itikii.:;'
'A l- aluation: $ 5 000 . 00
l- and 2-family dwelling 0 Commercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms: I
M
„.„ AMERPT9SWICAWRAMAT ,,,„,,,„,,,,r49.4,,
Total number of floors:
NititatAItik"Ztel.i':
Job site address: VIZ4-q Skiq T‘f mtog v_ks u z . New dwelling area: square feet
City/State/ZIP: 1166x () v., cri 11. Garage/carport area: square feet
Suite/bldg./apt. no.: Project name: A.NTA. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Flr.izmor
ef4A
Subdivision: mtavoy6 mu_. kAt . i Lot no.: Mo Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.: ‘S'715DC _ ok 6 60
_ __ equipment, materials, labor, overhead, and the profit for the
NRIAMAT:Vgrilfe: OfS7Mlifra&p'fibvolikare,": :mmiltions3to work indicated on this application.
itIgi:AftSTE46,'
tOW401\k M At NIA t\f‘ NO\NAVN Valuation: $
Existing building area: square feet
New building area: square feet
'' r " '''' IPitaEfV:44iriqr4 1 PVrllelr;;:TijiWAWffartW.: - 4
04( Number of stories:
Name: I■UsTV 301tAsii3t4 Type of construction:
Address: 0745 % „,k,c6t4. ...kv.., bv....
• Occupancy groups:
City/State/ZIP: -ribp-b , (YR. 1/23 Existing: .
Phone: ( viooso Fax: (P5 ) 69% 9-8(07... New:
kif,r
a41Mi41951ti
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 perforined. If the
Ct y/Sta te /ZIP: applicant is exempt from licensing, the following reasons
i
apply:
Phone: ( ) Fax:
E-mail:
Atv, .:i.,:,,,:s
h,.,z,„,,.:"
Business name: \NIVAVOTVg. fak...W.kkue16_ laiu MC
, " i '^` 4- 'i0Ze -77 :01 1 t , 'O'iMPVI:MIA• 1 4E0V - *:::;w:7TIRA
Address: ApA03 %,. WOCIS,1 VOUAtts,04 -V?.. .1k:t 444:::AiktOletS64ferliglihchediVekON z:::nik:,..'
Structural plan review fee (or deposit):
City/State/ZIP: sisw \ bK 0\109-9
Phone: (992) ao 044 Fax: (
FLS plan review fee (if applicable):
(t ?, )
CCB lic.: %41
r Total fees due upon application:
i k , Amount received:
Authorized signature: , , Ir y , /11/ ir ,
This permit application expires if a permit is not obtained
Print name: 1 141(1.\-\14 NI \-1-0St4 Date: ( A.t 0) within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
c. ( ) 7 7 77\c) ' PO Service Board.
1: \Building\Permits\BUP-RES PermitApp. oc 1 440-4613T(l 1/02/COM/WEB)
Building Permit Application Checklist ,, t
One- and Two- Family Dwelling FOR OF USE ONLY
City of Tigard Received
II N . g Date/By. Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits.
C Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 ❑Electrical 0 Plumbing 0 Mechanical
TIGARD
Internet: www.tigard- or.gov ❑ Other:
. THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW - Yes • N N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat /lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: [] ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ' ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
• prescriptive path analysis provide specifications and calculations to engineering standards. _
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and /or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ •
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\Building\Permits\BUP -RES- PermitApp.doc 03/21/06 440- 4613T(11/02 /COM/WEB)
. Plumbing Permit Application �� `�' n n 1 ? C Ll �l et
Building Fixtures FOR. OFFICE'USE ONLY
•
CI an
of Tigard JUN 1 12009 Received
- g DateB PermitNo.:fll [2a A r 13
q 13125 SW Hall Blvd., Tigard, OR 97223 C ITy OF TIGARD plan Review tVJ` �� --ll� tt l l� ICJ
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISIOr t
. TIGARD dpateBy
ate Ready/By: luris. ® See Page 2 for
Internet: www tigard or.gov
Notified/Method:
�. ,,.� <�:.._..� ���ou*:•ea*sz: -, ,�.� , �» .., ��• -w �,, . � .. a;��.r.M,_. �,. «.�. =. -u q ,
Supplemental Information
r: � :pp i3 �33t - �� = v ` ; �'"�v."��g v�Mnt ":�'�:� ", � �s= •�:. "?� - �..2:xr N., ; : <..;xw� • a �+�° - � �s;
i°4 ,li s; `t .P ..: ,� ,e .. . e " N r, � ` .$ r- .$ r,'e *••- .`.'3'._�'"a.� 1» `"4 -: '; s°'.
qtr-.. ��` ��.n_..��w���z...:.�����:�.• ..�:�_ r >.. ,,.,_ t . �t�'�;.� >.�'. �'b � a:- �e-<" �?= �-.' zka� .�FE'iE,�., .
HEDUI:E�..' -n � _.�i�. � �';
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty, Ea. Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'- ' *k,sk�e�t' tom=. xss� 9 ",� &.�;.*r.c- >���*ze;;�: s y��. �;���:;x.- �;,;��Y &,�r•._e��. e *�.r:.;_ n i�a>• sass•' SFR (I) bath 1 249.20 :
` .;,' awl > +i; .,�,)M�, :;vRz:'-` ytz,.,i
; i ,; - c tli„ GORY OF;,CONSTRUCTION, 11 _ s •:
.r >xa'�> " z ° :a. ,:�.� ��a�Wr, sae_ r -':- s�:+s�r;- �'r�sf- �a:���� .r,���:,� -: a�:
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ g ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: -
, c, .: - -:r > <,„ �_: r Fire sprinkler ( sq. ft.) Page 2
"
't „ ,F . ::J - ®B SI YN,F AN x 1 TIQN; ... ,, .:.; rr'
.., � .�� .m 3 4 „ �> ;. _,.>rt;�x.�.. «�,w��., -..., n... . , � ; ,40:* Site utilities
Job site address: i-/A- % 0 F, `w - Catch basin or area drain 16.60
City /Slate /ZIP: "1W.A), 01� q1Z27, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: 30w�3� Footing drain (no. linear ft.: ) Page 2
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: MO tw, mu, IA. \ l Lot no.: 46 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: i C .3.3 - 41'}00 Fixture or item
Absorption valve 16.60
~ , ,, , 4 �SCRI Tc10 � o f W 1' i 4 V `
. :
,
,.� .��e .. ..,�� �_ _ , 4 . z�.�, -�x� t, ; o U ..,r,.a � °... ����.�"' ` Backflow preventer Page 2
� MW\ INc• � V 4 la\AAN, Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
: , , .: „, :w -a4s. _ ,4 .,,., < h. t ug,. . ., v g tan 16.60
rx Drinking foun i
.. ' „ ,,„,,a:,,. : PROPERTY OWNER a §" „TENANT . , Ej
Name: 'T'l� Expansion tank 16.60
Address: 1?-�.t SUS F�1,CQN _..k_ 111; n • Fixture /sewer cap 16.60
City /State /ZIP: -ne;�� t AR C :t'' j 'Z,, Floor drain /floor sink/hub 16.60
Phone: ( - pi j ) v„,,4. i j -p0)0 Fax: (gj7))(0 6.862 Garbage disposal 16.60
�"� �� :,, k " ��:.,:., ":.:� * "�. a�v� Brae v¢;�- 16.60
- a. =' Vvt" ' , �. ,;. FS ose bib
;'„ A PLICANZ Ea..4.
❑ " - ® C�TPJ�RSOIYa = �
;.�. .....'.:?- �Rt,.?'.. "„ ., }rxs a�u .:.: s a��4. .. , . . .. < -'s"a r P. 2 :;'xT.'^m fi ".e- :,' ss:ecr;'.�€ .�� a..
"� Ic e mak
�� � �' 16.60
Business name:
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: Sink/basin/lavatory 16.60
( ) Fax: )
Tub /shower /shower pan 16.60
E-mail:
x; *yy� =t� z::. -:..; : , r, a: _, s = ",r " Urinal
, 16.60
:�; .;�;?;W`.,�:c a, tt�: �.._, ti.:�,�, ,��:- �,_.- .,��s��.�.,,., "�1''�' :�.�r� ` .:�, t .}:�;t:A.,» Water closet
��.., 5�:� >_ 16.60
Business name \ )W� P IV ' \IVI . �-� t 0 t ((\ PCT Water heater 16.60
Address: ' � • , • . / \ (trT \ ku - i�11Y Vi
1 Other:
/ ( (
Subtotal
City /State /ZIP: ��, ',I � 1 ; C\169".
��
Minimum permit fee: $72.50
Phone: ( ) , ,r 04; Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: ' . 4.(00 .. Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: , I , ' Am/ State surcharge (12% of permit fee)
110104 r TOTAL PERMIT FEE •
Print name: 4 \ 1 , \01.. V xJ1v Date: ( • k\- ' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\Building Permits \PLMF- PermitApp.doe 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:
. z'!
, wS,it Q - w Fee (e •Total `" S care F P .. -.t
�, �..... - �� ���, . .�,.� -� � � _ 4150
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
Valu n , ..
atio �PermitFee�
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
F)t t e 0 iti'ri A IM : ; 4 :NY IFe" 4efi ,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 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including first 0.00.
Subtotal: $50,001.00 and up $742.00 for the e first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: a ° ", .
�
Plan Re��,>tew. fors Plumb�i 'g�Installafioans��0.��,.,�;
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
greater, except systems designed and stamped by licensed
�,�,,���� �»�z� � , �Quant► t�tt >2y�(Ftxture;!R�ork.Perfo�med��
Fixture Type
engineer.
i �.E- 'ReplaceK
�� i z .- 4 Ca ed % t Added . Eust1n
,.. � � � � pp � R :� ❑ 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 `r =-, '7 ` fiTlsCtrleoI'5t'rlflg,�l'alll . .:
Eye 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 .\Buildmg\Permits\PLM- PermitApp doc 12/27/06
Mec na,nical Permit Application I ECF ' f "' FOR Of FILE USE.ONLY ,
El
City of Tigard Date/By: • .g
13125 SW Hall Blvd., Tigard, OR 97223 JUN 1 20U9 Received
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: PermitNo.: y: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD i Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard - or.gov BUILDING DIUISIO al Notified/Method: II() Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
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.
CATEGORY OF CONSTRUCTION Value: $
1- and 2-family dwellin RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special information use checklist.
y g ❑Commercial /industrial ❑ Accessory building
Multi - family ❑Master builder ❑Other:
Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job Z--}} _ ( ` C y Air conditioning or heat pump
ob site address:
�')(i4� SO ,k,o3\V �-1 J]'_ (requires site plan showing placement) 14.00
City /State /ZIP: i , 11.v'w —v pt� t \ {Z \ 0\--17i23 Furnace 100,000 BTU (ducts /vents) 14.00
JO�N�N Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work I/ 10.00
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
,� C � /vent for any of above 6.80
Subdivision: 4\ . (, i�'1�', '41O , i Lot no.: ' 1 tl9 Other: 10.00
Tax map /parcel no.: I SI D G .- 01 800 Other fuel appliances
DEESCRIPTION OF WORK Water heater 10.00
.J\ ` � , t Gas fireplace 10.00
\V tl , !t 1V\ 11 h t Flue vent ent gas
for water heater or as
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: KI'l* , Environmental exhaust and ventilation
Address: 13`4.5 5w k ?-
Range hood /other kitchen
equipment 10.00
City /State /ZIP: 1 ,)� 1r " ut,3 Clothes dryer exhaust 10.00 .
Single -duct exhaust (bathrooms,
Phone: ( i5i,ek �ery3 Fax: (rj0 (0 O 5565Z__ toilet compartments, utility rooms) ( 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: State surcharge (12% of permit fee)
mi n . , I TOTAL PERMIT FEE
V This permit application expires if a permit is not obtained within 180
Authorized signature: I Ill* / W I , ' r I days after it has been accepted as complete.
Print name: is,,--1 C ' .N 1 11 t Date: 0 - Iv 00) * Fee methodology set by Tri- County Building Industry Service Board
r:\ Building \Permits\MEC- PermitApp.doc 01/19/07 440 -46t7T (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
-c.re n el � n + p i T • Co L 2
Electrical Permit Application IIN Eij \f ug,- ` Rece .FOR OFFICE . USE ONLY
By: CC . o
1E9
City of Tigard L DateB Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 JUN 1 1 2009 Plan Review �` �9
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
• Inspection Line: 503.639.4175 OF Date Ready/By: kris: El See Page 2 for
Internet: www.tigard- or.gov CITY CF TIGARD Notified/Method: Supplemental Information
ft in r'oaoax nit pr.t...,.
TYPE OF WORK t���t lt "/[ N I`�it itU PLAN REVIEW
❑ New construction A 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. 1
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
g 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I ''44 L S 4V ALCO s `�S�D'� 100HP ore. occupancy.
❑ � n 0 Six or more ore residential units. Recreational vehicle parks.
City/State /ZIP: 11 GI b I . (A 'E' 7V� h ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 3 , JuNi ❑ 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: MO'w04,2 t ' 'W \ Lot no.: 4-(0 1,000 sq. ft. or less 145.15 4
} �^ Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
5 `33bC. — nI b00 Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
)woo 1V\ ) ��M{O ^A �r� Limited energy, multi- family
\'C\AF \ 1 ON residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
MA 1 WW 401 amps to 600 amps 160.60 2
Name: th U 1V �1N.
601 amps to 1,000 amps 240.60 2
Address: t? SW t J GM S_ ®v_. Over 1,000 amps or volts 454.65 2
City /State /ZIP: -'t"I(;,� NO t O, _ 1 '�Z 2; Temporary services or feeders installation, alteration, and /or
', `` NO relocation
Phone: (51 t 24 90 (50 Fax: (9 ) (p (p (0‘ 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, lg.se ret, , . i L I • , / 4 Branch circuits – new, alteration, or extension, per panel
or ex han?.e according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
] I • Owner signature: :,ti,61r1D(�11�, V T Date: 64-6°) A. Fee for branch circuits with
❑ AP ' LICANT ❑ CONTACT PERSON above service or feeder fee, x
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 2
first branch circuit
Address: Each add'I branch circuit ( 6.65 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
Business name: VV� k\kk _ MI i��' Signal circuit(s) e r limited -
1 /. energy panel, alteration, or
Address: 44 S J 1U ( ,bT r ��`' Q � 19?-- - extension. Describe: Page 2 2
City/State /ZIP: S . t 0 ' � G \ 1 05 "l Each additional inspection over allowable in any of the above
r �� Per inspection 62.50
Phone: ( 503 (,Q l l3 0` 4') Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 544. ( 0 Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: 4 Date:
Plan review (25% of permit fee):
9 i � State surcharge (12% of permit fee):
Authorized signature: i if �', TOTAL PERMIT FEE:
iliW VO � t 7.J, v W S 1 O06) This permit application expires if a permit is not obtained within 180
Print name: 1 Date: 11 days ys after r it has been n accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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 \ Building \Permits\ELC- PermitApp.doc 03/23/06
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
V1 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.
fl) \\\nO«) :�0,hron
Pri l r I. ame of Permit ' •plicant
.� /Ail A AA .o
Si. ure of Permit Applicant Date
Permit #: 1118TZOOL'(• 001c��0 , F
- mo)
l� 2J-1 S VQ k ,CY e l'�� ? O r . -;,
Address: � , 7 A.
F SS j •
k Iraq 0 *..+„,. ipiF •
• Issue. by: _'l Date: 7 6 S .
This Copy for Permit Offices