Permit '_ � , �, CITY OF TIGARD MASTER PERMIT
°!!' 0 ;',- COMMUNITY DEVELOPMENT Permit MST2009 -00155
„ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/21/2009
'TIGARD g Parcel: 2S112BB08500
Jurisdiction: Tigard
Site address: 14244 SW FANNO CREEK LP
Subdivision: Lot: 0
Project: Laskowske
Project Description: Add 440 square feet habitable space.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 220 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 19 Bathrooms: 0 Second: 220 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units. 1 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $44,858.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers. 0 Garbage Disp 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr. 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods. 0 Other Units: 2
Furn <100K: 0 _ Vents: 0 Woodstoves: 0 Gas Outlets: 0
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 & 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)
LASKOWSKE, STEVEN H & OWNER
TAYLOR, JULIENE G, 14244 SW
FANNO CREEK LOOP
TIGARD, OR 97224
PHONE: PHONE:
FAX:
Total Fees: $1,520.63
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. � ose 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 . .800.332.2344. /
Issued By: � �A aahib Permittee Signature: � /i, __ /// A-_
Building Permit Application •
Residential REC8VED OFFICE USE ONLY
Received
A � G�
City of Tigard 2 0 2009 Date /By: Permit No.: �Y I C 20 nq -` 0(5J
7 4
13125 SW Hall Blvd., Tigard, OR 97223 JUL Plan Review " f� J
Phone: 503.639.4171 Fax: 503.598.196 Date/By: ( ( J Other Permit:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: p /ef/e.7 n Juris: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method. p / -r I C7 Supplemental Information
TYPE OF WORK Q I 1 ` D DATA: l. 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.
1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 4L� 6.131•3 ❑ Accessory building ❑ Multi - family Number of bedrooms:9
❑ Master builder ❑ Other: Number of bathrooms:
:JOB SITE INFORMATION 'AND LOCATION . • Total number of floors:
Job site address: / #2..0 5I„/ :,,,,A„p Cfcel LO New dwelling area: 4 square feet
City /State /ZIP: 77‘..-8-,e...0 , OIL 9 722LP 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
FgAwt Cr-ea-g-- Pr/ ry e_ Other structure area: square feet
t/ REQUIRED DATA: COMMERCIAL -USE CIIECKT
LIS
Subdivision: Co d of,J y G+ K — r e - e__!1 7 Lot no.: 6,0 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.
Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑' TENANT" Number of stories:
Name: 9y /_9 g �t?v,, ,, rte.. Type of construction:
Address: I 1 4. 4 4 5 8,/ F Cr . L. , Occupancy groups:
City /State /ZIP: wT I g-11.1:11) / .1 d 1 :4 1,
(t � 9 Existing:
Phone: ( ) ) /i ,.t,,,, -- i3."05 Fax: ( ) New:
❑ APPLICAN ❑ 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:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: 0 1/0 9 ,. ,
Address:
0 ��� BUILDING PERMIT FEES
( refe to fee schedule) .
c `
—
Structural plan review fee (or deposit): C 00
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: AAtilote___ r >� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ,..51-4.v d.„,. ! N S Date: 7/41061 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Pennits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1/02 /COM/WEB)
I •
'
I .
Building Permit Application Checklist •
One- and Two-Family Dwelling . , - : „Fog OFFICE USE ONLY
:' , City of Tigard Received
Permit No.:
.
14
' q 13125 SW Hall Blvd., Tigard, OR 97223
1
. Date/By:
' ' M , .. Phone: 503.639.4171 Fax: 503.598.1960 Associated permits.
.. ..
- ...: 24- Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
TIGARD . Internet: www.tigard-or.gov CI Other:
. . .
THE FOLLOWING ITEMS ARE REQUIRED FOR FLA'S:REVIEW Yes. No - 'N/A
, . , - . _... .
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. DI 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 - 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan l=1 permit required. Include drainage-way protection, silt fence design and location of catch- I=I 0 0
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state DI 0 DI
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 0 0 0
_.
,
• / 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 0 0 0
, 4
and location.
.:
. 14 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 0 0 0
r
.,; 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- 0 0 DI
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. 0 0 0
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- 0 CI 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
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 0 12 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 Cl 0
,
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or 0 D 0
architect licensed in Oregon and shall be shown to be applicable to the project under review. . ._
• JURISDICTIONAL SPECIFICS - . ', . ' - - , , ' ' - - • _, , ,
23 Five (5) site plans are required for Item 11 above. Site plans must be 8-1/2" x 11" or 11" x 17". 0 0 . 0
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. 0 0 DI
25 Building plans shall not contain red lines or tape-ons. "Mirrored" building plans will not be accepted. 0 CI 0 . .
- 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 0 0 0
27 "Drawn to scale" indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, 0 0 El
and. protection measures must be drawn to scale and accompanied by the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 D 0
including-decks, patio covers (over non-impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I: \Building \Permits \BUP-RES-PermitApp.doc 03/21/06 440-4613T(11/02/COWWEB)
%
t \,
Mechanical Permit Application FoR OFFICE USE ONLY
Received / !% n M , q
City of Tigard Date/By:
No.: 7 OCIJIJ / — ere,/ 95 Date
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition/a teration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Ot er: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION • Value: $
1- and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
-/"' Job site address: / T 2oSIN j / ' C Air conditioning ngt pump
� (requires site plan showing placement) 14.00
City /State /ZIP: '7 0 1- / o - 970_24% Furnace 100,000 BTU (ducts /vents) 14.00
Fumace 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, 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
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�
," t Gas fireplace 10.00
vl Ott 1 >.» IF ) ✓Gl's ( 0 0 4- D oad tn/% // 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
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
• Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (33) 62_0 t 1 25 — wax: ( ) 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 /Z1P: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater ,
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: cr MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50) 7Z,)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) E, ,
1 H
/ TOTAL PERT FEE al + 10
`` This permit application expires if a permit is not obtained within 180
Authorized signature: f r .� / --� , days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
I: \Building\Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (1 I /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.
C\ Building \Permits\MEC- PermitApp.doc 01/19/07 2
1.
• Plumbing,Permit Application
Building Fixtures FOR OFFICE USE ONLY r - • .
City of Tigard Received ��7�
` r g Date /By: Permit No e ?J 9 -
. n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
. TIGARD Inspection Line: 503 639 4175 Date Ready/By: luris. ® See Page 2 for
Internet: www.tigard -or gov Notified/Method: Supplemental Information
t ,�
: �` Po '� "?Y ga:; :`v�.;1.. w, ,r '.dkrz; = �.s . il640 ,24'4 < *4 'At ;t ' „_ "''T'c+'"." . « .; ^...i.
.,.:e�s�',w�`: =�a,.a , '�. °.„• c �. , "��x+.' a ��; x ��h '�'' g �" a �-r � ";�t` .y�; ��:. as' . `�• -.
s,. : - 54 QE �vOR “.=_; a te: '' x . ,. r #-nom..:` r x �
�,:�- � .: -, . �'-,- �..;y�FEIa; - �:SCHEDUL�� ='A. -� vt ,. �; .
? �:�'":-'��--- s.p�- k�':d'A, air'€ �a_.: �% c�a��: �. �'' �.. r ;- � >r���3e'#� z�; <.. _._,.a r�,� -.wax; �: � §� 6:r ��".�x .-u. .v; .. .. rrsn:- a.: a�,;.., a�. n�.,,. m: �. c. �. .r�i�- ..:.;_.���'fra;'" .._
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. 1 Total
ZJ ditio Iteration/replacement El Other:
New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
�.. T AI, : ^ UC , . ,.:.: ; , x..
r ,
�;� "�;i , '��w� s�. °�: �,�.�,��.,�. �_h� >.:;,: • ���..g»'_. ,:A:A.�. �.,..r::R,,��,..s ,.�_a.�i��
�, ,-
.�.� �e_:°.?: SFR (I) bath 249.20
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ r g ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
. . - 4 u_ E �_» . «_- -, , Fire sprinkler ( sq. ft.) Page 2
.= . a � v= OR A 1VD LOCATION , . x
> _- �� _� � Site utilities
f[ Job site address: / t f Z 5(4) � ea , Nivo 0- Catch basin or area drain 16.60
City /State /ZIP: TIC---6-A_Q 0 / 72,2_ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ( Project name: Footing drain (no. linear ft.. _) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector k 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: g
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
�� t,�:. :;'" .�_ . ,•.z,.�.r �, {�v� ::��t�.� *, �rR:: � - « °�r- ur s� i � ,
.r.; >r i`- ;}:; � "' �..,r_� ��x.� �
;�.: ter„+ DESCRTh T®i OFtWORIt = s o , Page 2
.. � .:.�� t � .4.. :. - :..,,1„,:,. „-,, .< ,- s„ ..�,„ o g, � Backflow preventer
MOO (}l/ P /vim 6.7t/ j /0 ' -/a 0,,, ¢/ c,./rp (/ Backwater valve 16.60
Clothes washer 16,60
Dishwasher i 16.60
,? .3 zxw v -:,•. r �s r: ;; ;;.:z „-q�v ,c,; ,:r : :an , Drinking fountain 16.60
' " �t ; P L ' toPERTY�;,oWNER f ` r ® ' r - - r , s
' tom
':•," z---, n _,, .v�.�.aa' = . *_ : :. a e .v,'::01.-:;':1:45,; 1' vM,.. 1.-- - ss �; _ c,"at, Ejectors /sump
16.60
Name:
- Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: (3 ) 6, Zo /?ir35' <Fax: ( ) Garbage disposal 16.60
, �iiivi I . 14 , .: ,, Y h.� t . , f 4 az o'ktR 16.60
. % ' ' . o , vw x . ,- �® COI�ITA Hose i
n 4a� - a•.,.� x�,txs�' � 4 Ice maker
i
16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Pagc 2
Address: Printer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax ( ) Basin /lavatory t 16.60
Tub /shower /shower pan 16.60
E-mail:
Urinal 16.60
..,.-�, �,��_�,�� >;'?' � %h �. `_gi�:�.°�a'aa;r� °� - - aaw9.�V,',�,SL��`..e.,�e��,' ,:, a� ''^: =;:. ;�.�.r:^,•;e: ° - °,,e -�'�i
- t"" i * x CONTRA Reel t 4` . 1 <- ,fi�&2. Ik Water closet
x
_ . .. a�� �x�<._,�t�..4�s,�� -�.,. �+urC� .._ ._'. ,x�._ _ �:?K:�z� 16.60
Business name: Water heater 16.60
Address: OCR n p Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: ' / / State surcharge (12% of permit fee) � C
i ��, ang.L.r/ ". TOTAL PERMIT FEE t , 2
Print name: 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 Tri- County Building Industry Service Board
i \Buildmg\Perm its\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
S 1t e U , Q t y -" ii ) r €q "" =" s >< a g^tF--� " : :
°,.. . _ 74.. . � Fee ms Total Square Footage „ -3 Perm � t F ee..'. :,
Footing drain - ' 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
Water Service - each additional 100' 46.40 Medical Gas Systems:
"?- ,_.a�;..: .�.�,: •�•r;�� �.i'7;�r,,. .. _ :s� ^Sit' „- ��.n«.,.,;. ; � �. ,s ar,ay`,?,
aluation r Perm>�tee�� . r. x
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
ixture o
`` r tai # e e'(eaE Tota additional $100.00 or fraction thereof, to and
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work: € o' P a `Revi<ew for Pluimb g'o talla}�ons k
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
� :���a.�: .. .��.._
" 4. ;l:'; `- :' .; A.::} °; ; engineer.
':Eixture °;Type: . .,,.> ; �a, ": � : rdr "s� . , � . ., � � ?t- .x . ,.r
��a -: x,'" �' ��'," �>:,;: i"::z �?��.„', �.���:��.;a�:z���:".;� -. .kx,�.. "=i
A$101 WW,4. ff. o' / .g 4PA'� fik.4;?Capped Aetded': i, ;�Bzr3tin�� ❑ 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 a"° `''s" '. O w'7Mafi t ia`zt�ai�'"`�:,..T,- -also "' r r
Drinking Fountain �, Y150I11et1cQrS'EsllAgl"alll q
Eye Wash El 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:
•
i'\ Building \Permits\PLM- PermitApp.doc 12/27/06
Electrical'Permit Application FOR OFFICE USE ONLY
City of Tigard Received Date/13y: Permit No.: / , / g yy7 _ ev /59
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review J��
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Mil Inspection Line: 503.639.4175 Date Ready/By: Juris' El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction dditi teration/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 • It er: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
`] I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ 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 ", "I -3 ",
Job no.: Job site address: / 91'7 S � - ' v4/0 ( .. y , � 1 Six or or more residential R occupancy. Recreational
---/ / _i � 0 or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: / - ,[J ! ) 0 /` 72- ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 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 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
` r Limited energy, residential 75.00 2
X DESCRIPTION OF WORK (with above sq. ft.)
^ i' Limited energy, multi- family
/ A1 t / %1/11,- e /e G- a �e '� U 1 - 1 /1 �/ O +' , 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 ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: (513 ) 6 2.-C) — /305 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, exchange, ace. • d'. g to O ' 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
O wner signature: ` A:. _ : Branch circuits - new, alteration, or extension, per panel
nature:
` g / ,�,� Date: A. Fee for branch circuits with
,
❑ APPLICANT
❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: without service or feeder fee ' 46.85 1/4��
first branch circuit
Address: Each add'l branch circuit 7) 6.65 1`'\ ,1' 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: Signal circuit(s) or limited -
rr��� 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 Lie.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: I0G, ,pc)
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): i3, d 2
Authorized signature: TOTAL PERMIT FEE: 7 4 , g 2
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
C'Budding\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:
Systems*
A • udio and Stereo S
n y
n B • urglar Alarm
i n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
•
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.
p BUILDING DIVISION
a
a TIGARD TRANSMITTAL LETTER
lam– TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
REEFED
FROM: (;' -- /- �� j , AUG 1 3 2009
COMPANY: CITY OF TIGARD
BUS
PHONE: J 3 6 2,c7 ��=j ` I DING DI By, .mil
RE: - St ' �S G 4 / YuP•01,4.1 T2ocR • c�C� 155
(Site Address) (Permit/Case Num
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
:C.opres._ y Description:, , ,' `' ... Cop`ies. ., Description:.. ,
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.
Other (explain):
REMARKS:
'USE��ONLY � -
Routed to Permit Technician'' Date: et 2, Initialer i ck -
Fees Due: n Yes EVNo Fee Description: Amount Due:
.5 �.. $
Special
Instructions:
Reprint Permit (per PE): n Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
1: \Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07
Clean Water Services File Numb .
JUL 2 1 ?_009 [51.0® l3 I p _ .
C1eanWater. Services
By San - t itiv Area Pre - Screening Site Assessment
C t _
1. Jurisdiction.
2. Property Information (example 1S234AB01400) 3. Owner Information
I � S S Name: ' V ' �• ' 9 , .
Tax lot ID(s): ___1
Company -
Address: 5M
Site Address: City, State, Zip:
City. State, Zip:
2.. Phone/Fax: 0 ZO A .ii
Nearest Cross Street: E_ Mail:
4. Development Activity (check all that apply) 5. Applicant Information
'c. Addition to Single Family Residence (rooms, deck, garage) Name:
U Lot Line Adjustment p Minor Land Partition Company:
❑ Residential Condominium ❑ Commercial Condominium Address: '.tee /0'
❑ Residential Subdivision ❑ Commercial Subdivision W
City, State. Zip:
® Single Lot Commercial ❑ Multi Lot Commercial
Phone/Fax; —
Other
E -Mail:
B. Will the project involve any off -site work? ❑ Yes Wlo ❑ Unknown
Location and description of off-site work —
7. Additional comments or information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknoerledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to h ie and t sit I certify
that I am familiar with the Inform: ion contained In this document, a nd to the best of my knowledge and belief, this Information n is true, comp
.. •-• Printllypo Name � ,a - �
Print/Type Title dr/+`e
S ignature �� 4 -,3 ,
/ii �:- - -
Date ? of
FOR DISTRICT USE ONLY
❑ SERVICE PRO VIDE R L E TTER nlf site or Sensitive exi the s APPLICANT
n 200 f e e s o PERFORM j a ASSESSMENT
al Resources As A
Report
may also be required.
❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pre- Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
d• covered. This document will serve as your Service Provider letter as required by Resolution and Order 07.20, Section 3.02,1. All required permits and
ip provals must be obtained and completed under applicable local, State, and federal law.
Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s) found near the site. This Sensitive Area Pro- Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas If they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07-20, Section 3.02,1. All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached.
The proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED. � Z � O �
Reviewed by ,_ ) 5 � Date
1 n ,_ r'ho, , X0, U i; , inn I. nx. (K;3} (i i 3,V.VI '• wv \l rl q 'I' i r1Vi∎A t, O
7550 ; SIN f ldlshnr� , Iliglit�J��r • -1:1111E,1", t „ ann .. r l2, �.. � t ) - - _, .. .- -- _
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.
Print Name of Pe Applicant
/24/0
Signatur-' PermitApplicant OF Date
Permit #: ‘ 5 - 1 - - g . 0 0 - 0 0 ( 55S f
I Li � �( (- { "d F pf C• �.A .
Address: 1JU
02 g7a()-4 i Tgd
Issued by: Date: G' Di . 09
This Copy for Permit Offices
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CITY OF TIGARD - SITE PLAN REVIEW ,
CITY OF T[GA[tD - SITE PLAN REVIEW
�'� 66 ~ B UIL DING PERMIT NO.: • 2° " . 6(--- BUILDING PERMIT NO: �!� 2
•
, � , 6pproved ❑ Not Approved • PLANNING DIVISION: Not Approved
Street : App 0 Not Approved Required Setb ks: Approve pp ❑
Protect ted Trees: / Side: Str et Side:
Date: - ' + %
B : �Il , / Gar =e. Rear:
rio
Front. g
Notes: Vi sual Clearance: Approved Not A .L Approved
Maximum Building Het feet
CWS Servi• Provider Letter Required: Q s 0 No
Reeive
B1 : - s Date: 7 z./ o
EN INEEI ING DEPARTM 1 Q Not Approved
Actual Slope:% Approved
Plan: a Approved CI Not Ap +roved
B : i / ` _.. . = .Date: AK .
Notes :po _; eX e .I . , - . f rreva
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