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Permit CITY OF TIGARD M AER PERM III I COMMUNITY DEVELOPMENT Permit #: MS T2012 -00083 IT Date Issued: 05/09/2012 T I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S103BCO5800 Jurisdiction: Tigard Site address: 12275 SW TIPPITT PL Subdivision: TIPPITT PLACE Lot: 8 Project: Loewer Project Description: Kitchen remodel, replace /alter (4) windows, including patio door. Remove non - bearing interior walls. Gas line for new range. 5/24/12 Reprinted to add (5) additional branch circuits, subpanel BUILDING Floor Areas Required Setbacks Required Stories: 2 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: Yes Total: 0 sf Value: $30,000.00 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 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr. 0 Footing Drain: 0 Ice Maker. 0 Hose Bib: 0 Backwater Value: 0 Drywell -Trench Dram: 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: 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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 5 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 VB R - 3 0 Owner: Contractor: LOEWER, STEPHEN J & KATHRYN G TRNORTHLAND DESIGN & BUILD Required Items and Reports (Conditions) 12275 SW TIPPITT PL 20000 SW CAPPOEN RD TIGARD, OR 97223 SHERWOOD, OR 97140 PHONE: PHONE: 503 - 380 -6251 FAX: 503 - 625-4838 Total Fees: $1,257.32 ' 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. Those rules are set forth in OAR 952- 001 -0010 through O R1 L . 4 4 _P J'.i_ / 952-001-0090. You /i .'L may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 4 1 4 -6 6 - 1- + Permittee Signature: ' i or a.(kll 4 Call 503.639.4175 by 7:00 a.m. for the next available Inspection 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. May 24 12 11:05a p.1 • , .. . . . City Ti bata L • and Mk/ 2 , s..rpc nrit hie : M ST e t - 0b0 ED ,.�,a ea:e ��-� � l }r Tigard BV: 13125 SW Hall Blvd., Tigard, OR 97 n Plan Review 14 ... Mhune: 503.718.2439 Fax: 503.59881 2 4 2012 Date/By: Other Permit r 1 c ; n R ❑ Inspection Line: 503.639.4175 Date Ready(13y: /ucia: �7 See Page 2 for Internet www.tigardor.gov CITY OF TIGARD Notified/Method: -zl (O pplemental Information TYPE OIWil& .i U1 PE.AN REVIEW New construction Addilitlrt/ era tllrn placetnent Please check alflhal apply (submit 2 nets ofplansw .hicrnschecked below): Service or feeder 400 amps or more Building over three stories. Demolition Ot her: where the available fault. cunmt Marinas and boatyards. exceeds 1 0,000 amps at 150 'rolls or Flowing 'windings. CATEGORY OF CONSTRUCTION amp � g leas to ground, or exceeds 14.1100 t:ommercial - use agricultural ' 1- and 2- family dwelling Commercial/industrial Accessory building j Ostrallscsinillhatientaiims if a Pettuakibigito obtained within 180 'Multi - family Master builder Other: Fire pump, days after it hos bete uccsifitfiliMITAVIPPKVA or • t py' Ctiorrs allowed fa PC cr separately derived system. JOB SITE INFORMATION AND LOCATION Addition of new motor load id - A ", - 'b - - 1 -2 ", 1-3", occupancy. Joh no.: Sob site rddres : 100HParmom. Recreational vehicle park;. Six or more residential uaitsI Supply voltage for more than Cit C1P__J 4.2.••■Z2' Health-care facilities. I 600 volts nominal. Hazardous locations Suite/bldg./apt no.: rojcct name: T * IM12Q12 r Service or feeder 600 am E more. F E SCSCHEDULE � Cross street/directions to job site: 6 Deecription I I Qty. Pee. I Total New residential single- or multi - family dwelling unit. Includes attached garage. I Subdivision: ILot no.: 1.000 sq. ft or less i 168.54 4 Tax map /parcel no.: Ea. add'i 500 sq. ft or portion 33.92 l DESCRIPTION OF WORK Limited energy, residential 75.00 2 (with above sq. ft.) !r %) IC) ottilN 6 V 1 ) tp A , I r , Limited energy, multi - family I 75.00 2 /ti i A l jj fy`-C residential (with above sq. ft) *r_.'llerW)41C■ E�1b , ►C Services or feeders installation, alteration, and/or relocation ER PROPERTY OWNER TENANT 200 amps or less I li 100.70 %Cb .10 2 201 amps to 400 amps I 133.56 2 Name: 4 \L i 17.4 j ` . 401 amps to 600 amps I 200.34 2 , Address: 1 22- -1g- 660 t ' �-- t-74�.�.l 501 amps to 1,000 amps I 301.04 2 Over 1,000 amps or volts City/State/ZIP: ^ , i • - ■ i � Q ' 1 '� 2 2 ` v J l 2- n i g alteration, services or feeders installation, alteration, and /or 'Phone: ( ) fax: ( ) relocation I Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 amps to 400 amps I 125.08 2 Owner signature: 401 amps to 599 amps I 168.54 _ 2 Branch circuits — new, alteration, or extension, per panel Date: A. Fee for branch circuits with APPLICANT I CONTACT PERSON above service or feeder fee, each branch circuit I 7.42 2 Business name: k V l f 1 tom.. 1� co ) B. Fee service or branch feeder ee , without w '� i f r V V e W t..4J'v� service or fr fee, first Contact name: Ali M T V+ branch circuit 56.18 2 Each � 000 % . ` r. kl 9.4 , add'I branch circuit I 7.42 '. lQ 2 Address: utJ Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 � dwelling, service and/or feeder Phone: ax: : L- Reconnect only I 67.84 2 E- mail: 7 `C% W ‘aod t) Lt. 'ti 1 a to t s cat) U Pump or irrigation circle 67.84 2 CONTRACTOR t+v~ Sign or outline lighting i 67.84 2 Signal circuit(s) or limited - energy Business name: a� L r n panel, alteration, or extension. Pane 2 2 Address: Lh✓ � `�/ Each additional inspection over allowable in any of the above dditional inspection (1 hr min) 66.25 / hr CityiStater'Z1P: 'Rd investigation (I hr min) I 66.25. hr r Phone: ( ) r ' Fax: ( ) c Industrial plant (1 hr min) I 78.18/hr Inspections for which no fee is I / CCB Lie.: Electrical Lie.: Suprv. Lis..: specifically listed (% hr min) I 90 hr ELECTRICAL PERMIT FEES , Suprv. Electrician signature, required: Subtotal: 1,1.— .1613 Print name: Date:/ Plan review (25% of permit fee): State surcharge (12% of permit fee): ((, Authorized signature: • TOTAL PERMIT FEE: / cry, 3t/ Print name: 'Date: t1& dlding■Permits'ELC- PemritApp.doc 07;01/10 4404615T(1 f/05ICOM/WEB May 23 12 06:03p p.2 Authorized Signature: 6 Name Printed: P.,c'p, (...0 )ei Date: G Ja31apl Please FAX this completed and signed form to 503 598.1960. * '` DO NOT EMAIL THIS FORM. *** For your protection, this form will be destroyed after your payment has been processed. '*.... Ada 1 /00 5 Addl tiolil ' - su.‘• ViNK)e_. - 1 - c I:\ Bui iding ‘Forms\Payme ntAuthorization_031612.doc I l a CITY OF TIGARD MASTER PERMIT I Is COMMUNITY DEVELOPMENT Permit #: MST2012 -00083 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012 Parcel: 2S 103BCO5800 Jurisdiction: Tigard Site address: 12275 SW TIPPITT PL Subdivision: TIPPITT PLACE Lot: 8 Project: Loewer Project Description: Kitchen remodel, replace /alter (4) windows, including patio door. Remove non - bearing interior walls. Gas line for new range. BUILDING Floor Areas Required Setbacks Required Stones. 2 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: Yes Total: 0 sf Value: $30,000.00 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 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 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: 1 Furn> =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc1Feeders 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: 5 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 VB R -3 0 Owner: Contractor: LOEWER, STEPHEN J 8 KATHRYN G TRNORTHLAND DESIGN 8 BUILD Required Items and Reports (Conditions) 12275 SW TIPPITT PL 20000 SW CAPPOEN RD TIGARD, OR 97223 SHERWOOD, OR 97140 PHONE: PHONE: 503 - 380 -6251 FAX: 503 -625 -4838 Total Fees: $1,102.98 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 i = cor.a - 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. ' TENTION: Ore.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-.11-0010 through OAR a - 1 7 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Iss • d By: "/ 'Q �� Permittee Signature: t _ r ■ / . 11 _ 1�...d' Call 503.639.4175 by 7:00 a.m. for the next available Inspection 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. Minding Permit Application Residential FOR OFFlct: USE ONLY '' a eceived 1 / . ti�rA /� (/0 3 C of Tigard - D ateBy: I Permit N o.: i� • • 13 SW Hall Blvd., Tigard, OR 97 4 Plan Review n ■ APR no Other Permit: Phone: 5 Fax: 503.598.1960 R 1 2 2 Date/By: I'IGAIiD Inspection Line: 503.639.4175 Date Ready/By: ` 1uris: ® See Page 2 for q° Internet: www.tigard - or.gov X 0 01 f ar - Notified/Method: ✓ /P. Supplemental Information EL9i TYPE OF WORK • " ;, REQUIRED DATA: I- 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 [A ddition/alon/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the , CATEGORY OF CONSTRUCTION work indicated on this application. 4 and 2- family dwelling ❑ Commerciallndustrial Valuation: $ , 000 Q / ❑ Accessory building ❑ Multi- family Number of bedrooms: ^ 1t) � ( ❑ Master builder ❑ Other: Number of bathrooms: �/ J 0 Pr S JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 2 2.-1 S 5 \A) _ T t pp, Tr P1." -( i✓ New dwelling area: N A . square feet City /State/ZIP: -- k (-a (3 y C fl 2 Z Garage /carport area: Suite/bldg. /apt. no.: I Project name: 1.- O et( � � Covered porch area \ .r1 square feet Cross streeddiret ions to job site: ( 0^ti' OA ) 0r> J. ' J fa. Vn Deck area: 0 square feet 2W ='1 J L. on ; pp s - -t p `--"`j Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: (23 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.: 2 \ O 316 C O ?(--) O equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ V-i 17 t.7 c2. v..e.v- ] :. RFNI.ArF- A cl��R. 4 1..011. 1=CO.. A _ Existing building area square feet ,t. kAp` ` ` I Q r ,, ,w1 .1 �, New building area: square feet p- . FA i, l t� ►UZ VL ►�,1�.7ST (,l )tll�S l l�ln OPERTY OWNER ❑ TENANT A5 \{'l€ Number of stories: Name: �=J J `. \-"r t Y `- ,{ \ k. OTAA Type of construction: Address: t r � 9 1 5 , ) — CA p cpit.‘ TV Occupancy groups: City/State /ZIP: - 9 .l -� ©'� g'"'1aa, Existing: Phone: (5 rA 0 -- 1 �Y 1 n l.1.(") Fax: (^T,) — New: 1� ❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: (1 D 1(�� C�� � � �/` y �,p' qr � ` "'"Lb Structural plan review fee (or deposit): Contact name: ') 1 FLS plan review fee (if applicable): Address: r_ 0I M U3 , Ciq :' 't' oen tc - y � Total fees due upon application: �� � City /State /ZIP: Sile 'C�6 0,2_, cj-i ■ 40 .14 Q � . If Phone: (Fjd� ; , (D� s f F x :: (CD3 J as- (A 3 � OTOVOLTAIC SOLAR PANEL SYSTEM FEES* Amount received: r( d E -mail: 1\)3I 1 Y 1..\ Q \Ad ` Aid d , I l Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: I �� D e , Submit two (2) sets of roof plan with connection details 1 \ V 1 L V` &C O ' and fire department access, along with the 2010 Oregon Address: A ) f ( u3 Solar Installation Specialty Code checklist. City /State /ZIP: t P e rmit Fee (includes plan review � k �� C.' ` !�� and administrative fees): $180.00 Phone: ( � �j4 Q a � Fax: 33::, (�� . L4.`$ - D, c2-3 State surcharge (12% of permit fee): $21.60 CCB lic.: / D L { 0 Total fee due upon application: $201.60 Authorized signature: l J k n l� /� This permit application expires if a permit is not obtained � /� `l (J�) within 180 days after it has been accepted as complete. Print name: * Fee methodology set by Tri -County Building Industry f Mme( Date: 4 a � �,c�r Service Board. I:\ Building \Permits\BUP- RESPerrnitApp.doc 02/ 24/2011 440.4613T(11/02/COM/WEB) NIL- Building Permit Application Checklist ` ' One- and Two - Family Dwelling Folz OI Flcl: usi-; oNI.v Received City of Tigard Permit No.: I I / v 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By: C Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical Internet: www.tigard- or.gov ❑ Other: "I'1 -I FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW v es No N/A I 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 0 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. I I 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 ❑ El ❑ 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. ❑ ❑ ❑ 1 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. El El ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ El ❑ 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 Ore Ion and shall be shown to be ap plicable to the . ro . ect 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, ❑ ❑ El 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- RESPermitApp.doc 02 /24/2011 440- 4613T(11 /02 /COM/WEB) -- M e cha nical Permit Appl'cation- r I�ol� OFFICE USE ONLY City of Tigard � C, (l\\ i Received , M /� �I 1! , p._ Date/By: 8 Permit No.: )1$ rQV�O' �l �• Ill q 13125 SW Hall Blvd., Tigard, OR 97223 • B Phone: 503.718.2439 Fax: 503.59A.M0 Date Review Other Permit: Inspection Line: 503.639.4175 9 2012 - f I G A IZ D p Date Ready/By: • Juris: RI See Page 2 for Internet: www.tigard -or.gov ^ �� OF ��� A �� Notified/Method: Supplemental Information P1 1I1 IIIMP r\tlnro ,-,n TYPE OF WORK r t t a ' ` ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Q Addition/alt n/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* '(and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: � Air conditioning Job site address: 1 2 21,5 5 c c 7 . Tip cT p _ (requires site plan showing placement) 46.75 T Furnace 100,000 BTU (ducts/vents) 46.75 City/State/ZIP: —r n Q g ' Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: LO.el SR Heat pump (requires site plan showing placement) 61.06 Cross street/diredions to job site: 0M GlGO ( =- ko.cxrt'Asl. ZGl1 Duct work 23.32 1Z �T l_ Hydronic hot water system 23.32 C� ) �\{ t t.Jt 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 Gas fireplace/insert 33.39 C :- 11 1 , Li 7 ' \ 9-o\----/F, Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert _ 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: 23.32 Name: �'� ''<-( PK TV \ l S J Environmental exhaust and ventilation: Address: I 2 2.--/ ` e ) �-•�-� Range hood/other kitchen �W l \ equipment 33.39 City /State /ZIP: --"\---\ 09....... � Z 3 Clothes dryer exhaust 33.39 C -1 ♦ Q t Fax: Single-duct compartments, exhaust (bathrooms, Phone: C (�_ toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping: Contact name:` $14.15 for first four; $4.03 for each additional Address: �` ('N\ Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range J /4./5— CONTRACTOR Barbecue Business name: 1a --�� 01/4)1/4.. 1 a , r• r c) . Clothes dryer (gas) C V W Other: 0 Address: MECHANICAL PERMIT FEES* City/State /ZIP: o u 7nC - j c 9 [ \ 4..C\ Subtotal 14.1.5- •7 2 -� Fax: ( / ) Minimum permit fee ($90.00) 5.e.5 Phone: (r 13 3 t lQ C7 .S Plan review (25% of permit fee) CCB lic.: 1 c -DtAb� 1 Q State surcharge (12% of permit fee) . V ` TOTAL PERMIT FEE I ■ Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: (I Q n V�Y i I Date: • Fee methodology set by Tri -County Building Industry Service Board I:\ Buildineernit s\MEC- PermitApp.dac 03/07/12 4404617T(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. 1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 2 • May 08 12 11:52a p.1 Electrical Permit Application FOR OFFICE USE ONLY IIIIII City of Tigard RECEIVED Received • Fermi' 57 /a �(kjOf 13125 SW Hall Blvd., Tigard, O 9722 Dme'ev' a Phone: 503.718.2439 Fax: 503.598.Of)Q,/ _ g 2012 , �'Ian Review F{ 1 6 Other Permit T I Ci ;� K D Inspection Lune: 503.639.4175 Date ReadyBy: lure: El See Page 2 for Internet www.tigard or.gov Notited'Method: • Supplemental information TYPE OF OF TIC ARD � rtr., n1vISlON . PLAN REVIEW . _ .. ❑ New construction [Addition ter5t in/replacement Please check all that apply (submit I, sets afplarsw /items checked below): • ❑ Service or feeder 400 amps or mom ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fau :t current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 wits or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural and 2- family dwelling ❑ Commercial :industrial ❑ Accessory building amps for all other installations. buildings. El Multi-family ❑ Master builder ❑ Other: ❑ Fire puma ❑ Installation 0E75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition ofnew motor load of ❑ ".4 ", "E,' I - "I - Job no.: I Job site address: t Z2�T �3 —1--\ � p t.— S azupa �� \ ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: c�A 1 q 7 2 .- 7 2 ❑ Health-care facilities ❑Supply voltage for more than 2 - 3 ❑ Hazardous locuioas. 600 vo :Is nominal. Suiteibldg.lapt no.: Project name: Cl Service or feeder 600 amps cr more. Cross street/directions to job site: FEE SCHEDULE (F Qc C CxrAr't^:l >< � �. (')n , oe,u ue ;pri I Qtr. I Fee. I Tetat 1 • New residential single- or multi - family dwelling unit. i 2 \ST . r Ci4l , - 7"; \)_ ) i 7;r Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Es. add' 1 500 sq. ft or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OE WORK (with above sq. ft.) 75.00 2 - Limited energy, multi - family 75.00 2 I\ `- S C--;w1.- .T-7 -� _ 1�t -Q.vL l \ F`r" Y \' residential (with a bo sq. ft ) \ 1 Services ar feeders install ation, alteration, and/or relocation �( ri� 200 amps or Less 100.70 1 13 OWNER f ❑ TENANT 201 amps to 400 amps 133.56 2 Name: S - - r _,. e 1 i rt _ �� ---�` 601 ampsta 1,000 a s J 200.34 2 1L-A- 7 1. \ � , ' _ 601 amps to 1,000 amps 301.04 3 Address: t 22~ l ST )- ---; nom\ - --t– p (� Over 1,000 amps or vats 552.26 2 CityIState /ZIP: ` , c� � ( � v �� .2 2� Temporary services or feeders installation, alteration, and /or relocation l . 200 amps or less 59.36 I • Phone: (v) 9 c‘ f 0 Fax: ( ) I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps t?5 2 • intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 301 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits'uirh ❑ APPL]CA..Y , CONTACT PERSON above service or feeder fee, 7.42 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first .t Contact name: 2 �-�� {L' branch circuit 21 y 56.18 2 j �, �v � Each add'I branch circuit t 7.42_ 2 Address: Miscellaneous (service or feeder not included) City /StateiZlP: Each manufactured or modular 67 84 2 dwelling. service and/or feeder Phone: ( ) Fax : : ( ) Reconnect only - 67.84 2 E -mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR • Signal cirtuit(s) or limited- energy Business name: ' "C� k-) --• . f - mind, alteration, or extension. pyge2 � 2 r Each additional inspection over allowable in any of the above Address: � - R \5 � `c Additional inspection (I hr min) 6625/ ht City /Stale/ZIP: P \A Li ` /' ' l t C) t Investigation (I hr min) 66.25/ hr l ' `rj)J V Industrial plant (1 hr min) 78.18 /hr Phone: (t: -- C 4 35 t L t�C 1 Fax: ( 3) — , Inspections f whi no fee is specifically listed (;4 hr m 90.00/ hr CCB Lic.: 1S:51- 1 Electrical Lic.:34 —/ C 1 Suprv. Lic.: 6075 ELECTRICAL. PERMIT FEES Suprv. Electrician signature, required: C Subtotal: Plan review (25% of permit foe): 4 Print name: CH A-0 C}V ' Date: a f i I � Stare surcharge (12% of permit fee): At Authorized signature: / v. /t J- This permit application expires if a permit Is not obtained within 180 Print name: L l # ` ` I TOTAL PERMIT FEE: • Date: • days after it has been accepted as complete. / Number of inspections allowed per permit. 1.' ItuildingW PermitscELC•PermitApp.doe 07:01/10 440.46I ST( II /Of /COMIIEE