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Permit (9 109 ,� �� b e e u,�-, L L . CITY TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2009-00142 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009 Parcel: 2S104DB02200 Jurisdiction: Tigard Site address: 13217 SW ROCKINGHAM DR Subdivision: Lot: 0 Project: Shimanovsky Project Description: Add upper story to residence. 8/6/09, adding furnace and a/c to scope of work. • BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 4 Second: 364 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $42,338.32 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 3 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =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 addl 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) SHIMANOVSKY, ROMAN & INNA V GLOBAL HOUSING INC 13217 SW ROCKINGHAM DR 7917 SW NIMBUS AVE TIGARD, OR 97223 BEAVERTON, OR 97008 PHONE: PHONE: 503- 315 -4259 FAX: 503 - 296 -0612 Total Fees: $1,400.52 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. ATT ON: Oregon = requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 10 through OAR 952 -0' ; 00. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. , ` ll Attic pp Ism( d By: � a I JL� Permittee Signature: �" • • RECEIVED AUG 0 6 2009 CITY OF TIGARD BUILDING DIVISION fi ^ hp� ' �l W i N -N a a A cegr NJ 4 CITY OF TIGARD MASTER PERMIT 'I a COMMUNITY DEVELOPMENT Permit #: MST2009 -00142 T f G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: • 07/28/2009 Parcel: 2S104DB02200 Jurisdiction: Tigard Site address: 13217 SW ROCKINGHAM DR Subdivision: Lot: 0 Project: Shimanovsky Project Description: Add upper story to residence. BUILDING Floor Areas Requi Se tbacks Reauired Stories: 2 Bedrooms: First: 0 sf Basement: 0 sf •Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 4 Second: 364 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $42,338.32 Rear: 0 PLUMBING • Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 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 Heat Pump: N Hoods: 0 ' Other Units: 3 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =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! 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) SHIMANOVSKY, ROMAN & INNA V GLOBAL HOUSING INC 13217 SW ROCKINGHAM DR 7917 SW NIMBUS AVE TIGARD, OR 97223 BEAVERTON, OR 97008 PHONE: PHONE: 503- 315 -4259 FAX: 503 -296 -0612 Total Fees: $1,400.52 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. ATTE Irn • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -I :. 0 through •AR 95 • -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 50 6.. or 1.800.332.2344. 332.2344. Issue By: _�I / /41 • _� Permittee Signature: Q1� �A� V Building Permit Application Residential R ECEIV E, FOIL OFFICE USE ONI,v City of Tigard Received 111 JUL 0 6 2009 Date/B_ N Permit No.: ,i ii is` S 13125 SW Hall Blv Tigard, OR 9722 Plan Review � � Phone: 503 F ax: 503 .598.1960 Date/13 :11��� ll, Other Permit. T I G n R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready - r : _ El See Page 2 for Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: _ - 41 J Supplemental Information • TYPE OF WORK REQUIRED DATA: 1- 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. - and 2- family dwelling ❑ Commercial /industrial Valuatior�; zz f Accessory building Numb ee�t edr0 ❑ ry g ❑ Multi- family ❑ Master builder ❑ Other: Number of bathrooms: • JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: ( 2 i4 5 c Keck i 69A Atn C. f New dwelling area: square feet City /State /ZIP: TIG jt12.ci OR ?"7V ,/ Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: e ;,tit aVS y Covered porch area: square feet Cross street/directions to job site: / 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. }4erM2 A iJrro - Valuation: $ • • Existing building area: square feet New building area: 57 ((square feet ❑ PROPERTY OWNER ❑ TENANT ' Number of stories: Z • Name: 5 M 1 tic two ustcY ee �stfa,eteo�: A pro SZ 7r� 5_7_1 Address: t Z fl SGJ R.meki k devi W't C.+ ®een f peft City/State /ZIP: TI ell Co( OK 0 � "�"Z Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT ❑ CONTACT, PERSON , NOTICE Business name: CLctext 4. d't ac.4. 5C I trC All contractors and subcontractors are required to be Contact name: O-. R.K. V , k0 (/ GC V licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: cj (? cS C__) iti L try-o8 Lc 5 ti V2 jurisdiction in which work is being performed. If the City/ State/ZIP: (3 cc, v e tf f or" ©R 4 CO E applicant is exempt from licensing, the following reasons apply: Phone: (g) 3 'c(ZS°T Fax: :(St3) - ?to O E -mail: CONTRACTOR ' Business name: 6 Lo R ,qL -( 0( S r.' C oJ - J. -vtC BUILDING PERMIT FEES* Address: 3- (7. S W N i tvc g u s Fi U (Please refer to fee schedule) City/State/ZIP: 62,�c.vec - O c.. © 2�0o g Structural plan review fee (or deposit): a5 - ( O FLS plan review fee (if applicable): Phone: (sm 3 (3 • (z5-9 Fax: (S G 2 6. 4f 00 � 6 O ^Z c� 0 I ` Total fees due upon application: CCB lic.: ( O T `Y 1 Amount received: Authorized signature: � r r // C � i _ J GC V I/f (S?�(/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. N Print name: I l t k V (c A & U Date: 7- -G - Og ► Fee methodology set by Tri -County Building Industry ��— Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(1 I /02 /COM/WEB) t Building Permit Application Checklist " One- and Two - Family Dwelling roiz ()Friel: tish: ()NIA' City of Tigard d Received g Date/By: Permit No.: Blvd., q 13125 SW Hall Blvd Tigard, OR 97223 Associated permits: IN C Phone: 503.639.4171 Fax: 503.598.1960 P r . I �, A li D 24 - Hour Inspection Line: 503.639.4175 ❑Electrical ❑Plumbing ❑Mechanical Internet: www. tigar d- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ,'es No NA 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ • 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ 0 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. 0 0 0 7 Water district approval. . ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ 0 ' 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 a, 'licable to the sroject 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. I:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB) 0 FROM : FAX NO. :3608285370 Jul. 07 2009 05: 24PM P1 Mechanical Permit A lic atton ECEIVED , , ,,, , 1 , , , ,, ,,., , Tigard Received 13 SW Pi n Tigard, tit. 97223 JUL 1 3 2009 + )10/1467:2,0491 - csa/ yZ • - { Phone: 50139.4171 Fax: 503.698.1960 f .� gd`r9 4 CITY OF TIGARD remit: rage for _.. BUILDING DIV ISION" : 4applemenatlarormotion ' • .'...:•' • _ TVA Or WOR1 - �. c0. 1MEkC PE SCHEDULE - i>5 Ci�t„1� 1ST ❑ New construction 01 Addition/alteration/replacement M Mechanical penult acne` are based on the vahte of the work El Demolition In Other: Per lbmdet 10111 the vane (rounded to the Roared dollar) of nil rr/Cdtehical !..,_ eta utufpnsmt lah o v he d, and profit j ": - 'CATEGORY OIR cops uJ(' TjoN - value: S - .- ..- • 1 -thud 2-family dwelling ❑ Commercial/industrial - • : :�' .R $t Q U P M ?/'�$ Fes' ❑ Act essozy building - . 0 Multi-U=4 0 Master builder 0 Other: Air award aejivlstv/iova we Chcc . i7�Crdplka Qt y. 1!e ! 'fatal . !d.O3 SflE 10 AND LOCATION 111cadtgt/ooddldag Job site address: J 5 a 1 / S I 0- CDC k ! n c? Viz. C.4- , Air conditioning or heat pump , (inquires ale plan sdknrin onemneat) 14.00 City/Shrtc/ZlP j : t - r p a_. Furnace 10%000 BTU (ckromlvcals) 14.00 Svitclbldg.lapt. no.: Project llama 10001101 BTU (dam) 17.90 Crow skeel /direction W job alts • • -- Cia beat panto 14.00 Pact wink . 10.00 .3 Hydronic hot water system 14.00 Residential bowler (radiator or 14.00 . .. Unit heaters (Del-type, not electric). in -wall, In -d!!0., saspondal, etc. 14.00 Subdivision: ,.... Lori no.: Fluc/vont for any of above 6.84 Tax map/pmnr:) nn.: - 10.00 -^ Other rod indlaume 1 . • . : : i w s c d I P ! [ d N OR W O R K Weer ht 10.00 a MO S.c..c a�9/c1. 1/ r lie 74r, / Hue vemfor water heater or gas 1000 6 - fireplace _ 10.00 • • rag liphtet (gas) 10.00 Wood/pellet stove , 10.00 - Waxed firoplaanlin9pt _ 10.00 ; �'� "" . ,f '` '1C t!R'Nl$ Q � C'himney/lbta/0rtelveat - ^ - 10.0Q _ . 1 10.00 Plante Environmental ashaast wad ventilation Addteaa: M Range hood/other kitchen - City/StatelT.hP: - _� . _. cquipmerlt 10.00 Clothes dryer exhaust 10.00 Photo: ( ) Fax , Smglc duct exhaust (bathrooms, ex: ( ) toilet cornpanment Wilily 6.80 • • p CONTACT PERSON fans ... 10.00 Business moot: G 60 8/ G getC Si h - 74C. - other 10.00 Fad tiniest Contact name: fry? a rk l/ko, 0.V /SAO ter bit fifer; SUM Omega additional Address: 7R 17 3c....) N t Bets nve - r Gas teat zutup - -- City/State/ZIP: 6eave(s' vr" 0 R 4 ?-o O ? Wall/suspendedlunit heater Photo: (SzS) 61G -�( F a x ; Water beater h;-n il: 1 3 a - ( 12.S4 cot W ;,q taco . ._ • . . ' . .. • • . • • . • • cONTRAC'[OR r.� R -.. >� /-/e621-1,-; ) Bush= name cast / 1 /7 C r Ot a Addnss: W!0 /I / s'e, ' mgcil AL nis., cit yaw co 0 v(-?ie.. V) G Subtotal M invgrrm permed fm (R72 SO) 0_ Phone: Z (5 r � 7c V_i S's VS -- j Pax: (3b v) _ , Lt. -0.53 C] CC 91ic.: I j q & , - > State swcharge (12%of p fix) 6.7C) Al % TOTAL PERMIIT trEE 1. 71� Authorized signature: Y ty • C (ft/ ibis permit appla�ttoe eaplrea it a 0.+e pre is and olgaiued male no � !Y �. dqs attar tl tau kalif em aecepred q0. comptue Frigt name: 1 D ? i5 i? j C H4.yL V Daft: 07 - aq • Fee melkoddegy an by T .Ccumy Building mdueay Service Board mibsio Dill507 440.4$17r(11107N:nre/p7na) Plumbing Permit Application D ��E D Building Fixtures iiVV�J . FOR OFFICE USE ONLY - City of Tigard JUL 13 2009 Received Date/By: Permit No/45 T a� 9 - 9 - 4 / 4 Z V 13125 SW Hall Blvd., Tigard, OR 97223 y ' Re view C Phone: 503.639.4171 Fax: 503.598.1 S '� QF T1CiA Date Plan By: Other Permit No.: T I G n R D Inspection Line: 503.639.4175 G DIVISION gUILD1N Date Ready/By: Juris: Ea See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WO • FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ` ddition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 13 Z p- 51 R a c k (cAg'Cla w. c Catch basin or area drain 16.60 City /State /ZIP: 7 ( G iiq g d .o ct I- 2 - z 3 Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: I Project name: 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: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item Absorption valve 16.60 r DESCRIPTION t�. TION OF .WORK Backflow preventer Page 2 & (c .rc.rI/ ad: +et MO WI. Backwater valve 16.60 J Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER • I Drinking fountain 16.60 ❑ TENANT - 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: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 • Ice maker 16.60 Business name: 6°6 C Jau S rCet Q T.4.49 Interceptor /grease trap 16.60 Contact name: tc rk V. keoR ct- v Medical gas (value: $ ) Page 2 Address: ?Q i Z S i t gC -c S- WM., Primer 16.60 City/State/ZIP: (32sud,._ c)g 9 '''° 8". Roof drain (commercial) 16.60 ( S) (3 Sink/basin/lavatory 16.60 Phone: . c(Ls� I Fax: (g&) 6Z6- .7..wa Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: "'j TT ro S 4 �u C +I 0 iu f PI U Irn co I +t)j TIUG Water heater 16.60 Address: qty) S w £ I w o o d 5' t Other: City/State /ZIP: '-� 1 Lso,d, no 1 7 2ti Subtota r Minimum permit fee: $72.50 `7Z Phone: (S0`3) ei I - 1 g pp Fax: (x'03) 762- - 82 $ 4 Residential backflow minimum permit fee: $36.25 CCB Lic.: 1 a t Plumbing Lic. no.: . 6 .S(0 w ° ) Authorized signature: State surcharge (12% of permit fee) . 7c I TOTAL PERMIT FEE l `20 Print name: Z 0 K1 C i v -t Date: 7 (Q (o q This permit application expires if a permit is not obtained within 1 1 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building \Permits\PLMF- PermitApp.doc 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: Site Utilities Qty. Fee, (ea) Total Square Footage: Permit Fee: • 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 Valuation: Permit Fee: 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 Fixture or Item Qty. Fee (ea) 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 $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: Plan Review for Plumbing Installations 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 Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ 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 Isometric or Riser Diagram 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: is Building \Permits\PLM•PermicApp.doc 12/27/06 • . a RECEDE Electrical Permit Application l o k ( ) T : ( If ,: t 4)\I 1 City of Tigard JU 13 2009 P-04.-.1, a�.q_ �iq 13125 SW Hell Blvd., Tigard, OR 97223 r Pion: 503.639.4171 Fax: 503.598.1960 CITY TIG v 1 ' °a Review °� Permit: Inspection Line: 503.639.417 Cl i i OF �� are ® ere tai for lntarlet tUrrw.tigead•or_gw : ILDING DIVISI � .: sappteareoW ,at4rtpatfm i.: ;_ _, . - , Pant name. .0 New construction 7 .J Additionl al teration /replacanent ❑ Demolition ❑ Other w ' -.0 � ' , 1 tie cheek all that ap (submit of plans wMe d iked be if ,,: _. ...: . =. -, r_: -: _ .1r,. 0 Service er hed t elope a mom I i Butic ing Walk= atones. 1- and 2- family dwelling 0 Commercial/ industrial 0 Accessory building " de avm7eble taut chalet! p marinas end boatyards CI Multi- tittnil El Master builder eaooecda (0.000 amps m 150 votes or 13 Floating builc6ngs. 0 O ther: less to ground. or exceeds 14,000 ['Commercial-use agricultural _ _ , llmpslbr all o1ha mstaltrtioas Installation _ -. ?,_ 0 F �: ue pump. 13 In4eIteton of7S KVA w Job no.: lob site address: , �f , ye / Q Faae em amer rspard der "em � ^ � 119 .im of syst cavrm o torloadef 1:1 City /State/ZIP � i , - t t7 / ! 100FPorname. occeptaay. Q Six or more residential units. O Rect tnna vehicle parks. Suite/bldgJapt. no.: Project name: Q Kealtb.eare facilitics 0 Supply voltage forntme alms Cross street/directions to job site: IJ fiatard� io�oaa 600 wits sommal. D Service a Reda 600 amps or rune. New nsidendal Subdivision: I Lot no.: Includes a garage. multi-finally dialing unit. Tax map/parcel no.: 1,000 sq. tL ar less - 145.15 4 Fa ndd'I 500 @. a 33.40 k Limited energy, residential Add / 7'"f pt `whh above sq. a.) 76.00 2 Limited energy, mufti - tinnily 75.00 2 residential (with above eq. R.) 4 _ "' ' r ., ■ = Strokes or feeders tnetailattoa alteration, and/or relocation Nerve: • _ -. 200 amps or leas 80.30 2 201 amps to 400 amps 106.85 2 Address: 401 amvs to 600 amps 160.60 2 601 amps to 1,000 amps 2,40.60 2 City/State /Z1P: Over 1,000 amps or volts 454.65 2 Phone: ( ) I Fax: ( ) Temporary services or feeders installation, alteration, and/or relocation Owner Installation: This installation is being made on property that I own which is not 200 amps or less 66.85 1 intended for sale, (ease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 amps to 400 amps 10030 2 Owner signature: Date: 401 amps to 599 amps 333. 2 : . Breach (matte — e alteration. or attention. per panel _ .`- A. Feefbrbrandtclr w Business name: ( t;_. L f 1 o(J h o above service or feeder fee, 6.65 2 v I each branch circuit Contact name: v 4t 1,, v ko I/ 't .�, B. Fee for branch circuits without service or tbeder Re, b Address: 7/ i7 SW NiOn acts A frrstbranch circuit 4686 2 Each City/State/ZIP: $ eck e..- o v O R ct 7- 00 e Misc add'l th us (s d ic e 1 6 ) J (p ' 2 Miscellaneous (service or facto not ieeltMt� Phone: ( 5'503) 3 C3 - C(251 l Fax: : ( s'6-j) 6 a6 _lel co Each manufactured or modular 9090 2 dwelling, service ased/or feeds E -mail Reconnect only 66.85 2 " to nrlgffiton oink 53 40 2 LL c 5. Pump Business name: 5i4 IVs l 1 T L I e -- e i L, C. Sign or outline lighting 53.40 2 /� p 9 C C -# B Signal p a n e l , a or limited- Addtass: d foe /l/ J � energy panel, alteration, or WA etension. Dasatbe: Page 2 2 City/Stete/ZIP: Ilan h!`.Q Lf ve . WA . 9 86 C I Each add itmall inspection over allowable in a : of the above Phone: G6o S/8 -76-", I Fax: (360) (,) — 5$121 Per inspecton 62.50 CCB Lie.: f ? k9 Electrical Lit:.: C 2 3o f Supra_ Lie.: Investigation per hour (1 hr ads) 6230 1 � `� Industrial plant per hoar 73 75 Setprv. Eletxri an siigtia required. - ` 7 7 . --- 1 1t , ,; Print natter � Z—S I / � /@R E it /� fie: ©7� Plan review (25% of permie fee): Authonzedsignature: .�jEQGHFi liohaAR/t�:TCli Statesurdt E . r 12,E TOTAL PERMIT FEE � � �� 1:18w104.PriarksIELC4PaulltAppthac 4527106 440- e615l1 11111SICOMIWFB