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Permit
CITY OF TIGARD MASTER PERMIT . II COMMUNITY DEVELOPMENT Permit #: MST2012 -00086 T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012 Parcel: 1 S133CD10400 Jurisdiction: Tigard Site address: 11776 SW WILTON AVE Subdivision: COTSWALD MEADOWS NO.3 Lot: 136 Project: Dutko Project Description: Adding two windows and fireplace opening in dwelling structure for vent to exterior attached dog house. 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: $500.00 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 0 Drains: Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Dra Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders 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: 3 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 & 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: DUTKO, LAWRENCE DREAM HOME FINISHERS Required Items and Reports (Conditions) 11776 SW WILTON AVE 3630 SE HILL RD TIGARD, OR 97223 MILWAUKIE, OR 97267 PHONE: 503 -484 -7612 PHONE: 503 -422 -0854 FAX: 503- 794 -0617 Total Fees: $249.01 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 do n acco •a : with ap• •ved • - This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 da . ATTENTION: Oreg• • aw -q rest you to follow the rules adopted by the Oregon Utility ' tification Center. Those rule: - _ s • • • ' OAR 9 2- 001 -0010 through OAR i -00,r 0 :0. ay obtain a py of the rules or direct questions to OUNC by ca 5 03.232.1987 or : • . 2.2344. la Is ed By: ` Permittee Signature: A \ � � Call 603.639.4175 by 7:00 a.m. for the next available inspection date. W I.- This permit card shall be kept In a conspicuous place on the job site until com, . on o e pr. Approved plans are required on the Job site at the time of each I - pection. Buildin ' Permit A t 1 lication ` Residential , : - FOR OFFICE LiSE ONLY k City of Tigard i , 11! \ by?: bpi- D '1 q 1 ., 0 Permit No/ (57:204?— dDD�'6 13125 SW Hall Blvd., Ti itl Plan Review C Phone: 503.718.2439 Fax: 503.598. , %V Date/By:� Permit: T i G A R D Inspection Line: 503.639 1 OF ' ' 'c' GN' kQ Date Ready y: kris: ® See Page 2 for Internet: www.tigard-o L D!NG � r , t% S\d N Notified/Method: 77 Supplemental Information TYPE OF REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed. Addition/alteration/replacement Indicate the value (rounded to the nearest dollar) of all rep ❑ Ot her: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1`s 1- and 2- family dwelling ❑'Commercialindustrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / / 7 /76 sit) to iftn A- t- New dwelling area: square feet City /State/ZIP: ,i,. i 77, ar� Og 9 7 Garage/carport area: square feet Suite/bldg. /apt. no.: / I Project name: D v m Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet j,! C v REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I 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: $ ( e. CNN_ 2 w ■ wile' w C1,4 e tlr'e Q Ur..£P-- 64:g InDJ1..2 Existing building area: square feet cJ New building area: square feet X PROPERTY OWNER ❑ TENANT Number of stories: Name: 4 a , r i b ✓ / Type of construction: Address: // 7!l'G StiJ W ///90 TA Occupancy groups: City/ State/ZIP: T1.a Di 9' 2 Z3 Existing: Phone: ( 3 ) 4 -1-7$/2, Fax: ( ) New: ` APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* /I (Please refer to fee scheduled Business name: D re� ,I,i I D ni -e yt , S Ian Structural plan review fee (or deposit): Contact name: Ja rr e g rtn ` 5 FLS plan review fee (if applicable): Address: 3 ( 0 S, 1:1,‘ City/ State/ZIP: ` Total fees due upon application: �aui m u kc k, b R 72.�� Amount received: Phone: (50'y1 p - i . . e t y I Fax:: ( ) 79 - 0(0(1 fPa1 Y�F` n o f r e e PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: �1�p CONTRACTOR Commercial and residential prescriptive installation I roof -top mounted Photo Voltaic Solar Panel S m. Business name:-\ .`, „ Submit two (2) :: of roof plan with ion details � 3""" and fire department a •;.s, along with . e 2010 Oregon Address: !1f . , gE .LFi(( p Solar Installation Special . • , e c, cklist. City/ State/ZIP: l( `o �1 ) 9V i l/ Permit Fee (includes plan iew $180.00 ` T' -� and adminis 1 . . e fee - Phone: (r0 5) ci. .. _ ©$ s Sr i Fax: ( 5tg ) 799 , ( 5 (, /7 State surcharge (12% ' ' permit fee): $21.60 CCB lie.: V'31 . • yl03 Total fee due .pon application: $201.60 Authorized signature:` This permit appli Lion expires if a permit is not obtained within 180 days ter it has been accepted as complete. Print name: "` tL f Date: (,/ Z ' ' Fee methodology set by Tri -County Building Industry Service Board. Apr 24 12 05:20p Jamie DECEIVED 503- 7940617 p.2 Electrical Permit A l'>f 2 5 2012 `` Foy. t_Ptl( L It;L (' I.1 City of Tigard p [lore.8 : Y Pemlii No /Oleo /Z.. Ue7T3 1 • 13125 SW Hall Blvd., Ti v:. ' Pii sit TIGR Plan Be.ie., a Phone: 503.7)82439 F it t• : 460 i �'B Other Permit: -- i G ,t d: n Inspection Lis 503.639.. I G DIVISION °"` ready y }v: I 0 See Pace 2 for Watet: www.tigardor.gov NotdtdAlahod: i SopFlemental tefoenraicn • TYPE OF WOW( PLAN REVIEW New construction I' su chect et dbat a9Dl .Isabni t s1. o p wfire checked below): ❑ AdditioaralleratioMreplaccmenc a ) ❑ Demolition ❑ Other ❑ Service a (eater490asps a more ❑ Building o.0 three stories. whcm rh: available lime warm 0 Marius and boatyards CATEGORY OF CONSTRUCTION eacmds 10ACOamps al ISO volts or t❑ Floating boildittys. t - and 2 - family dwelling ❑ Commercia�ndusaia! r less topound. Drawee 14.000 0 Ca®tcaid -me agriwlraul L] Accessory building ;arms for an other irorrllwiore, buildup. ❑ Multi- family ❑ Master builder ❑ Other: . ❑ Fire room ❑ tneane:ion of 7S KVA or .108 SITE INFORMATION AND LOCATION ❑ E acecy syste largo separately derived swim ❑Md kiwi of new motor load of ❑ - A ",'£ Id ",'l - �'. lob no.: 2611 _ 3/ I lob silo address: 11776 SW Wilton AVE. IOOHPor more. Ocarpoecy. • ❑ Sim or mum: raeidenri l unite. ❑ Itccreatiemal vehicle parks. C Tigard, OR 97223 . ❑ tltsathut racoiuns. 0 Supply voltage for men thee ❑ Hazardous lnealiona. COO volts nomrd. Suite/bldg./apt no.: I Project name: ❑ Saws is feeder 600 amps. or mere. t FEE SCHEDULE Cross street/directions to job site . nr.rrladae I Om I Fes. 1 Tow New residential single- or an olti- family dwelling unit. Includes attaebed garage. Subdivision: I Lot no.: 1900 se. R or lee, 168 54 ; 4 Tax map/parcel no.: fa adds 540 sq. 11. rd portion 33.93 r I Limited encray. residential 75.00 2 DESCRIPTION OF WORK (with above sq. rt.I , J ? ! — Limilcd anergy. multi- fern 7S 00 ' 2 ,!4-d LL' 1,r/ Ilryf2 .esidential ftntbabovc SCI n.) Services or feeders installation. alteration. and/or relotatioo RP in rciT-e O l s I ; ✓r goo i 200ampa ce less 100.70 t 2 ❑ PROPERTY OWNER ❑ TENANT 20) ergo wa00ernes 133.56 2 Name: ' 40) amps to 600 any 200.34 2 60) amps to I,OU(t amps 30).04 2 Address: : <Zez 1,000amps or volts 552.26 2 City!5tate.21P: Temporary' services or feeders installation. alteration. and/or r relocation Phone: ( ) I Fax: ( ) , Memos or fen 593E - ( 1 Owoer installation: This installation is being made on property that I own which is not 201 amps to 4110 any 126.08 2 intended for sak, • 401 amps to 599 amps 1 6853 1 lease, rent, or exchange, according t ORS 447, 4a9, 670, and 701. Owner yi ettr7e' Ii reach circuits — new. alteratioo. er cslt lion. per panel )'� : Dale: I A. Fee far bran:I circuits with ❑ APPWCAhT I ❑ COnTACT PERSOty above =evictor feeder the, 7.42 ]. 2 I cacti branch circuit j Business name: 4. rc_ roe brand. circuits wiraor:r r service or feeder fee, fin: Contact name: branch circuit / % t A r ' 2 Each adds branch circuit ,,.. 7.42 (4 rat 2 Address: t Miacellsneoiu (serv. tee or feeder sot ioctuded) City/State/ZIP Each manufaearrtal or modular 6; 2 dwelling, service smiler ender Phone ( ) Fax:: ( ) Racnnectonly 67.84 t 2 E-mail: _Pump or irrigation civic 6714 Sian or outline lighting 6:.84 2 COW IR*C OR _ Sigiel arcuit(s) or limited -enemy r I Business name: �J1NL'.(•�11 6 � /i(/I,CfI -- C ctWPS 11 47. traa:l. _ Paget 2 i Each additional iaspetdtna over allowable in any of dm above i Address: , ` l 6 6< 14 . Addrticanal inspection (1 hr min) 662514 i L �/� W 4/2 �_ 70/5" J Invcstan n (I 1 min) 66151 Fr City/State/ZIP: ` /� {{ Industrial plant (I hr min) 8.191 hr } .. _ Phase: ( 8 . ; . g Q I Fax: (5-0 ) 30 7 9 9 Inspections ter which ire fee is 90.001 tr ctrieal Lie.: i Pry. Lie: 'J specifically fisted ('is hr min) r CCB Lie : j ,i p 7tf7K 0 ELECTRICAL PERMIT FEES re Suprv. Electrician signatu, [squired: l 1011 Plan review permit fee): i eO • sr Prior name: .., ` �; / Dale) . . z r State surcharge (12% of permit Re): f �, r 2-- Authorized signature: Or s � /A yer '/ TOTAL PERMIT FEE: 7 7 , 4 ,e07 n. moires iresife permit ki nut permit days after is hn been aeopted an ampler. obtained within 1gD Print name: . iLr/ Dale; Nismtaa of insmaions allowed pia permit. 1 'd 66696Z9CO5 SMV d9Z :50 Zi. bZ Ay Mechanical Permit Application roll officE usi.: ONI.X Received ' / City of Tigard Date/B `I f /9- Permit No.:M a� _c/ rr)8. 1111111 a 13125 SW Hall Blvd., Tigard, OR 9 E CRVEO Plan Review trtm Phone: 503.718.2439 Fax: 503 .598. D ateBy: Other Permit: - r I G � R D Inspection Line: 503.639.417 APR 2 5 2012 Date Ready/By: Jurist H See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information CET! OF 11(3.4'n TYPE OF (Q� iiihl ; nIVi;iON COMMERCIAL FEE' SCHEDULE — USE CHECKLIST Dv7 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 Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use check/Lst. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: ///7 9 4 Guy ` ( Av Air conditioning lob site address: (requires site plan showing placement) 46.75 t H Furnace 100,000 BTU ( ducts/vents) 46.75 City/State /ZIP: T� .1 ° / g ( 3 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: y/ Project name: DV + a S " Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 �_ii �- () Gas fireplace/insert k 33.39. 1 7 S kQO �i G� S t --AkrQ ?tact Flue vent for water heater or gas Sf- _ •B f t 4 J e �� Q � (' , .. at � fireplace 23.32 23.32 cork-. Q' `^ 'Q1✓ Log lighter (gas) Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 33.39 City/State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: QA-D Other: 23.32 ` _ Fuel piping: Contact name: o.h \) p,e $14.15 for first four; $4.03 for each additional Address: Fo x 6, as, Furnace, etc. Gas heat pump City/State /ZIP: T et ( r a gig_ SP 40 Wall/suspended/unit heater Phone: (.5-03 77 Y- 71 Fax: : ( ) Water heater Fireplace I 1 I tik E -mail: Range 9 CONTRACTOR Barbecue Business name: IZ A--- Clothes dryer (gas) Other: Address: Po W A MECHANICAL PERMIT FEES" ' City/State /ZIP: b r ''� \0.,,,,� era_ Q 29_444 Subtotal 4 Minimum permit fee ($90.00) 'k L,_ Phone: (503) 7 7y _(� Fax: ( ) Plan review (25% of permit fee) � CCB lic.: 9'S25�P ) I �� ( I State surcharge (12% of permit fee) IO,e-� ! TOTAL PERMIT FEE t 0 , Authorized signature: This permit application expires if a permit is not obtained within 180 n ` days after it has been accepted as complete. Print name: V ` pnt •(. I Date: z c'f • Fee methodology set by Tri -County Building Industry Service Board 1:\ Building \Permits\MEC- PernitApp.doc 03/07/12 44 1 7T(II /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. IABuilding\Perrnits\MEC- PermitApp.doc 03/07/12 2