Permit u CITY OF TIGARD MASTER PERMIT
IN C COMMUNITY DEVELOPMENT Permit #: MST2012 -00047
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/06/2012
Parcel: 2S109AB03600
Jurisdiction: Tigard
Site address: 14246 SW 133RD AVE
Subdivision: THREE MOUNTAINS ESTATES Lot: 29
Project: Gruss
Project Description: Adding new beam.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $1,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker. 0 Hose Bib: 0 Backwater Value: 0
Drywell -Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 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:
ALT SF 0
Owner: Contractor:
GRUSS, DANIEL L AND MARY E THAD METZGER CONSTRUCTION Required Items and Reports (Conditions)
14246 SW 133RD AVE PO BOX 1494
TIGARD, OR 97224 SHERWOOD, OR 97140
PHONE: PHONE: 503 -625 -2802
FAX:
Total Fees: $130.79
This pe . . . . . . . .s u b j e c t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • •ne in accordance ith app • - • plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d: s. ATTENTION: Orego I: . req • es ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• -2- 001 -0010 rough OAR 9 • 001-0% , may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or ; • • 2. 344.
I - ued By: — Permittee Signature: _ / _-
Call 503.639.4175 by 7:00 a.m, for the next available Inspec • on date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
Fire Protection System RECEIVED FOR OFFICI: USE ONLY
City of Tigard p 6 Re wJI Permit No.: M y7 aD , -�_at) a 13125 SW Hall Blvd., Tigard, OR 9722 NR 2012 Plan Review ►!� � !
14 C Phone: 503.718.2439 Fax: 503.598 Date/13y: 41 iJ kip. Other Permit:
T I c. n It D Inspection Line: 503.639.4175 C i fry OF TIGARD Date Ready/13y: Sufis: 121 See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ N9v construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (romded 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.
1211
21 l- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 1 0001 e)•C'
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1'1 .2 14. 5(„..„ i , rd A(e New dwelling area: square feet
City/State/ZIP: T-, 9 ar f ii Gila 2'( Garage /carport area: square feet
Suite/bldg. /apt. no.: P roject name: I�� 1 f t4 ,65 Covered porch area square feet
Cross street/directions to job site: $c (/ ,..,..r R. d Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
N Valuation: $
l '1y3"au, tiew r 445 to 9er
,� J J D _G poG5 `'A t .e^ Existing building area square feet
�` v T / New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: ) A 1 G is ' 5 Type of construction:
Address: I K 2 9(, (A. ( s J . 3 1"d a V _ € Occupancy groups:
City/State /ZIP: $ ;N rd � j - 4, 7 Z 7 `"I ` Existing:
Phone: ( ) Fax: ( )
New:
APPLICANT CONTACT PERSON NOTICE
Business name: '14 I Ai, 6 (, ei Cd &i 1140. J 01 All contractors and subcontractors are required to be
Contact name: 1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: Qp a p,e-- ( ((i c( jurisdiction in which work is being performed. If the
City /State /ZIP: I11. e /i,,i Coed Dg. Ct 1 ((. f 0 applicant is exempt from licensing, the following reasons
p�
apply:
Phone: (5-0 q6 i,... -50c6 Fax: : (.r 6i Lr_. GI e r 4
0
E- mail:14w) Via() /4ver7 Coil s Ire. G [) out , ro"A
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
I.
Permit fee:
Address:
State surcharge (12% of permit fee):
City /State/ZIP: FLS plan review (40% ofpermit fee):
Phone: ( ) I Fax: ( ) (Due
upon application.)
CCB lic.: la 70 q 7..._ Total permit fees: _ ^
Authorized signature: . /—� Amount received: I n 0. '`
This permit application expires if a permit is not obtained
Print name: 4 kW J . 0 L C., r • Date: 3 ,-G •-- l Z within 180 days after it has been accepted as complete.
�J • Fee methodology set by Tri -County Building Industry
Service Board
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Mann Project Valuation: $
•
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
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