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Permit n CITY OF TIGARD t eff� MASTER PERMIT IN — ilt • COMMUNITY DEVELOPMENT Permit #: MST2012 -00140 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012 Parcel: 2S102DC04900 Jurisdiction: Tigard Site address: 9204 SW EDGEWOOD ST Subdivision: 2006 -051 PARTITION PLAT Lot: 2 Project: Teny Project Description: 571 square foot addition for accessory residential unit. 10/11/12, reprinted to add (1) lay, (1) water closet, (1) shower stall, (2) vent fans & (1) 100 amp feeder. BUILDING Floor Areas Required Setbacks Required Stones 1 Bedrooms. 1 First: 571 sf Basement 0 sf Left 5 Parking Spaces 0 Height 20 Bathrooms. 0 Second 0 sf Garage 0 sf Front. 20 Smoke Dwelling Units' 2 Third 0 sf Right 5 Detectors Yes Total 571 sf Value. $59.338 00 Rear 15 PLUMBING Sinks 1 Water Closets. 1 Washing Mach. 1 Laundry Trays 0 Rain Drain. 1 Urinals 0 Lavatories 1 Dishwashers 1 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer. 0 Tubs /Showers 1 Garbage Disp 1 Water Heaters 1 Water Lines: 0 Drains' 0 Catch Basins 0 Bckflw Prevntr 0 Footing Drain 0 Ice Maker 1 Hose Bib: 0 Backwater Value 1 Drywell- Trench Drain' 0 Other Fixtures 0 Other Fixture Units MECHANICAL Fuel Types Air Conditioning' N Vent Fans 2 Clothes Dryers. 1 Heat Pump N Hoods 1 Other Units 0 Furn <100K• 1 Vents. 0 Woodstoves' 0 Gas Outlets: 0 Furn > =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 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 Secunty 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: ADU SF VB R - 3 571 Owner: Contractor: TENY, GEORGE TTT CONSTRUCTION & PLUMBING, INC Required Items and Reports (Conditions) 9210 SW EDGEWOOD ST 9210 SW EDGEWOOD ST 1 Ersn Cntrl 503 - 639 - 4175 TIGARD, OR 97223 TIGARD, OR 97223 PHONE PHONE 503- 358 -7769 FAX Total Fees: $2,863 14 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 = • • - = 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. AT NTION. Or- on I. requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 -001 1010 through OAR : : -00 -001 You may obtain a copy of the rules or direct questions to OUNC b 3.232 199877 or 1.800.332 2344 Issued : : / 4r / • Permittee Signature 1/4 ' 1 - litif t± s Call 03.639.4175 by 7:00 a.m. for the next available inspection e. 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. IN CITY OF TIGARD MASTER PERMIT C ' COMMUNITY DEVELOPMENT Permit #: MST2012 -00140 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012 Parcel: 2S102DC04900 Jurisdiction: Tigard Site address: 9204 SW EDGEWOOD ST Subdivision: 2006 -051 PARTITION PLAT Lot: 2 Project: Teny Project Description: 571 square foot addition for accessory residetial unit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 571 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 20 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 2 Third: 0 sf Right: 5 Detectors: Yes Total: 571 sf Value: $59,338.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs /Showers: 0 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 1 Other Fixtures: 0 Drywell -Trench Drain: 0 Other Fixture Units MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 1 Other Units: 0 Fum <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: 0 201 -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 +ampNolt: 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: ADU SF VB R -3 571 Owner: Contractor: TENY, GEORGE TTT CONSTRUCTION & PLUMBING, INC Required Items and Reports (Conditions) 9210 SW EDGEWOOD ST 9210 SW EDGEWOOD ST 1 Ersn Cntrl 503 - 639 -4175 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: PHONE: 503 - 358 -7769 FAX: Total Fees: $2,628.06 This permit is ' d 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 accordance 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 day . ATTENTION: Oregon <w re• ' es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 -001 -0010 through OAR 952-01 • Y 90. u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / / � 7 Iss d By: i...._ (/i Permittee Signature: )( �� Z 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. 1 Building Permit Application fl _ 4 ;C Residential ,JUN 2 0 2012 Fc1IZ (IFFict: ust: ()NI., . City of Tigard P�F� Received /_ //�_ llL�� /^ /i/O .� Date/B (,Q / , ! "- , A Permit No.:� (J d`�"�! `f q 13125 SW Hall Blvd., Tigard, OR 97223 �J �� IG�� ®p� Plan Review ► 4 I � 1 Phone: 503.718.2439 Fax: 503.598.1 j LDIWQ DIVISION Date/By: 0 ; v' 7 (CJ tZ der Permit a -bA .,. , A i , ii Inspection Line: 503.639.4175 Date Ready : y: / / tuns ® See Page 2 for Internet: www.tigard - or.gov 4fie ethod: ,-(J Supplemental Information TYPE OF WORK REQUI) . D 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. ❑ 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 33S ® Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: Q Q/ JOB SITE INFORMATION AND LOCATION Total number of floors: t Job site address: $14 faye gr New dwelling area: 57/ square feet City /State /ZIP: 7J411. D OR 972023 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: g Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet 70 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. Valuation: $ • Existing building area square feet _ New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: c t0wt t NV Type of construction: Address: 9200 S ( ,e &dc P a ccd sr Occupancy groups: City/State /ZIP: Ti t; AR D mfl2 9 7.?.?3 Existing: Phone: ( .SO3) 9 70 - /8g Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable): Address: Total fees due upon application: City/State /ZIP: $' gy Phone: ( ) Fax:: ( ) • Amount received: $(6,25.e? E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of - roof-to. ounted Photo Voltaic Solar Panel System. Business name: Tconsizac iOAJ 8. P/ /M.16/ y� //44--- Submit : (2) sets of roof plan with connection d . s (/ and fire dep. •• ent access, along with the 20 ' Oregon Address: 9a /O S� Eden:, f Solar Installati • • Specialty Code chec. '. . City/State /ZIP: 7 j4 titRD Qiz q 7.e.(3 Permit Fee •• ludes pl: - •mew $180.00 and ad : • alive fees): Phone: (103) .3s - g -776q I Fax: ( ) State su r • :• :e (12 %ofp° -•• it fee): $21.60 CCB lie.: 480363 /� A/li/ly Total fee due upon appficatio $201.60 Authorized signature: (] e-y/i • This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: <'EQ2r/ - /-c Date: * Fee methodology set by Tri -County Building Industry Service Board. I:\. Building \Permits\BUP- RESPetmitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB) ---.4 - Building Permit Application Checklist One -.and Two - Family Dwelling Soli oilier: USE ONLY Received City of.Tigard Permit No.: li 4 13125 SW Hall Blvd., Tigard, OR 97223 AateBy: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical T I G n it D Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes NO N/. 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 ❑ 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. _ 1 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. 4 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 Ore:on and shall be shown to be applicable 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, ❑ ❑ ❑ 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 02/24/201 I 440 -4613T(11 /02 /COM/WEB) 'Plutrlbing Permit Applica � ° � "a� � City of Tigard JUN 2 2012 Received Date/By: �t p" 1.2. `/�}/3 . Penult 56ap/, -4V/00 a 1 3125 SW Hall Blvd., Tigard, OR 97223 1 G Phone: 503.718.2439 Fax: 503.59 T "f� Plan Review Date/By: Other Permit No.: T I GA K a Inspection Line: 503.639.4175 B' 1�� DING i w �� 10 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov V Notified/Method: Supplemental Information _ TYPE OF WORK FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master l builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 :9:009t ' JOB SITE INFORMATION AND LOCATION Site utilities: / p e . 7,2.2.3 s j Catch basin or area drain I 18.76 I Job site add ress: } �� SIB E c/dJ 7Od tY T/44 RD OP q Drywell, leach line, or trench drain 18.76 Ci /S /ZIP: Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: I Project name: 4ccef.°`y Z//2f Manufactured home utilities 50.03 Cross street/directions to job site: 9 Manholes 18.76 M ain drain connector / 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 `/Clothes washer 25.02 NC Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: c-0 ie4. 6 TEA/V Fixture /sewer cap 25.02 Address: vac S & E / WBt i j Floor ge disposal sirlkmub 25.02 )4 Garbage disposal I 25.02 City /State /ZIP: 774/1 OR C/ 72'3 Hose bib 25.02 Phone: ( b3) 170 - a 11 I Fax: ( ) Ice maker 1 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: 777 CphS j 8 P /t/10j bine //u . Medical gas (value: $ ) Page 2 (/ Primer 12.51 Contact name: e* zee i / LAN oof drain (commercial) 12.51 Address: 9?/ 0 S IX 6 dfeleek," j j N' Sink/basin/lavatory 1 25.02 City/State /ZIP: 7740-R p DIL 97Zt 3 Solar units (potable water) 62.54 Phone: (S03) 358- 776 9 Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR g Water closet 25.02 Business name: 7 eOlt f /QL/Pa i O" g ph,..., j j y .�., / Water heater 37.52 Q Water piping/DWV 56.29 Address: 9.1 / O S a 6:diva-cod Jr Other: 25.02 City/ §tate/ZIP: % % O. f O,e q.7.U_3 Subtotal Phone: (s 3 S g 776 i Fax: ( ) Minimum permit fee: $72.50 Plan review CCB Lic.: /B 0363 Plumbing Lic. no.: P135/0 lik State surcharge (25% of permit fee) -per e (12% of permit fee) Authorized signature: tjgp r, / TOTAL PERMIT FEE Print name: 4"ED,e 1 � /y y 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. 1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440-4616T(10 /02/COM/WFB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qtr. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 • $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 • Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to P and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for .hours (minimum charge - 2 hours) • each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge- 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure Bath -Tub/Shower -Jacuzzi/Whirlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain ' Eye Wash Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. Car Wash Drain Garbage - Domestic , Disposal - Commercial Industrial Comments regarding fixture work: Ice Mach.Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall , Sink - Bar/Lavatory - Bradley - Commercial - *Note: If the fixture work under this permit results in an - Servicc increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet • Urinal Other Fixtures: I:\Building\Permits\PLM- PermitApp.doc 2 Mechanical Permit Applicatio FoR OIL FICI: usi.: ONI.\ City of Tigard a_T i � �' Dace Plan 14' Q I * Permit No PAS �� r pU� 13125 SW Ha Blvd., Tigard, OR 97223 Iii Plan Review • Phone: 503.718.2439 Fax: 503.598.1960 q Date/By: Other Permit: Inspection Line: 503.639.4175 JUN 2 Q 2� 12 Re T I G A It D Date p Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov Notifed/Method: Supplemental Information CITY OF TAG 1_ h TYPE OF WO UI l l )1VIJiV1V COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction I 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 checklist. ❑ Multi - family • ❑ Master builder ❑ Other: Description I Qty. 1 Ea. 1 Total `A0 JOB SITE INFORMATION AND LOCATION Heating/cooling: _ Air conditioning Job site address: S ( ,k- gd8e ( , t /,. Q() , 17 (requires site plan showing placement) 46.75 City/State /ZIP: T 4 �D 02 L' 7a�3 Furnace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 1 Suite/bldg. /apt. no.: Project name: 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 Pale hood c lot/ ie1 r y� Q Gas fireplace/insert vent 33.39 ► l/' X Au 4 � 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 I 1 PROPERTY OWNER I ❑ TENANT *Chimney/liner /flue /vent 23.32 Other: 23.32 _ Name: ('c7EG t? 7-6-__A-/V Environmental exhaust and ventilation: Address: 9a2 AO f k e�OO Fc/f d f / r Range hood/other kitchen J equipment 1 33.39 City /State /ZIP: Ti c Me ok Q 7 e ? Clothes dryer exhaust 1 33.39 v Single -duct exhaust (bathrooms, Phone: ( q70 - /O 7I Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional_ Address: Furnace, etc. Gas heat pump City /State/ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: sans-J.-tine Hearin-, i f / v C, f vq j� Clothes dryer (gas) Q Other: Address: /4,289 S C (k' 7 leg s 7 MECHANICAL PERMIT FEES* City/State /ZIP: HQ )) y i / /e o,Q �QI6. Subtotal / Minimum permit fee ($90.00) P e: ( 9;13) q (69 - ,r( S Fax: ( ) Plan review (25% of permit fee) CCB lic.: �o( 7 / 4S State surcharge (12% of permit fee) _ TOTAL PERMIT FEE t Authorized signature: Cit9 r This permit application expires if a permit is not obtained within 180 O days after it has been accepted as complete. Print name: 4'C -az4 F 7� N(/ Date: • Fee methodology set by Tri County Building Industry Service Board 1:■Building \PermitsVMEC- PernitApp.doc 03/07/12 440-4617T(I1 /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 • Electrical Permit Avgl,3'cation City of Tigard %plait Ne.: Web2 — 60/61 IN ..,.‘ 13145 SW !bill Mt. T i g a r d , 97223. ' Pb2I Review ' Phone. 503.718.2439 Fax 503.598.1960 • Dolan!.. Other Pamir �. Inspection Lim 503.039.4175 Damn Radrlrt,. hail■• B are Pea 7 a. Internet: wWw.1igaid -or.guv tdoiii dJMNtmd • (8Up emmlal Inforanaloe TYPE OF WORK PLAN REVIEW 0 New construpion ® Addilion/ulteration/r�cplaoemcnt o ehedc 08 dim Apply ( _ mon alphas w►kom checked below): pservi.. or feeder 400 elope or more d Beading over three sterlct ❑ Derruhlitlon ❑ Other what the ',nigh; Pans caned O lames and baafyaeds. - • 2. CAI OF CON TRUCI lON • meads 10.000 amps at 1m vainer O Floating buildings. • has m gamed, or mash 14,000 O agtiatMal and 2- family dwelling CI CAmmercialindustrial 0 Ac essory building • • mss(br all dher installation buildings. . Multd- tbmily 0 Master builder 0 Other. O Fire pomp. O InsWIlation d 7s KVA a JOB lrrE INFORMATION AND 'mentor D Cmergtotr Mom. �asr !cif derived Waco- ��'� DAdtitimatlearmomrtm ' dot p "n 2 ". "1� ". Job no.: � I Job site a d d r e s s : y 4 , f 1 V J i� C A r O � I . e 006 0 S O Six ar mwo,m emtid units. D Itcacational vehicle parka. City /Stater /1P: 74 /1 a 1Z) CR 9 74 3 o Health-cm facilities. o Sap* voltage fee more than O i'wardens locations. • boo wilts Nominal. Suite/bldg./apt— no.: I Project name: Ave U ni % D soviet Of feeder boo amps Of MOM - FEE SCHEDULE (:Toss sneet/directions to job site . New residential single- or mold dwelling unit. • lacludes attached pr>g e. _ Subdivision: R . I Lot no.: - 1_000 Bq or le ss 168.54 4 In wkI 1 5015 R. or portion _ 3192 1 Tax map/pared no,: Limited energy. residential DESCRIPTION OF WORK (with above se. ft) 75.0 2 Limited energy, multi- fmnily 7100 2 residential (with above tar. IL) Services or feeders Installatioalteratton, and/or relocation 2n0 amps or his 100.70 2 er PRROPE OWNER Y 1 1 0 TEiANT 201 amps to 400 amps 13356 2 4 ales iL' �y 401 amps to 600 amps 200.14 2 Name: S/L 6011n ps to 1,000 amps 301.04 2 Address: R1 OD S Lk Ed ee,2ods / Ova 1,000 amps or volts 552.26 2 City/State/ZIP: / i !r , P D C 4L q 7.413 T or feeders Installation. alteration, Sadler Phone: (col) ei 7v- /8 N I Fax: ( ) 200 amps or lase 5036 1 Owner installation: This installation is being made on property that 1 own which is not 20 t�nu a to 400 amps 125 08 2 intended for sale, lease. rent. or exchange, according to ORS 447, 449, 670, and 701. I amps to 599 amps 168.54 2 Brach circuits - newilkratioa. or extension. par pond , Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT I 0 coiracr PERSON above service or itxder fie, 7.42 2 cadr Nance circuit Rusinest name: B. Fee for branch circuits »trAosa ., service or fader tiq Ant 56.18 2 Contact name: dh Man circuit • . . • Erich add'I Mara circuit • 7.42 2 • Address: Miocelancoas (service or feeder not included) City/Stater/AP: dwell atalfar Wes Phone: ( ) 67.84 2 I Fax: ( .' ) • �Reco Reconnect only 67.84 2 — Pump or Wigwam abale 67.84 2 E - mail: _ Sign or outI1n or outlaw lighting 67.84 2 CONTRACTOR RACTOR Signal eireuit(o) or Itmited•enagy Business name: f h u I /yhf t '` 1,'1.-•C, panel, alteration, or osteylon. Palm2 - 2 Lath additional Inspection over allowable is any 9f the above A d d r e t t : 2 O v 0)E 6 5 - 4 v1- 6 5 Additional inspection (1 hr mom) 66.23/ hr Cily/Statc! /.JP: 0001, f.Ot. .k.ef - (A/ /9 9'86 6/ (! brain 66.25I hr • Industrial plant (1 hr min) 78.18/ hr Phone: (360)578 - ?-se 9 . I Fax: (3bo) 3./6— ?6 6-07 I®patiom for Midi No fee is 90.09/ hr J it g ( d2 3 a I �'• f' 3 5 soaulbwla listed ELECT irh) CCB l.ia: .Z � Electrical Lie.: S LiC.: 9' 6IiC1'RIG1I. i PERMIT FMB Suprv. Electrician signature. required:7C .1,�Gl l `,r,.,•_ Subtota Flan review (2545 of permit le ek Print name: Oh es 1 erse t�R'err c /f Date: 7 -z r ....2 1. surcharge / State (12%ofpamit kek TOrAI. PERMIT FEE: • Authorized signature: • This pamit impresario aspirates prods is sot obtained within 180 Print name: I Date: • . s air h Mar Gem accepted as samp Number of Iaspeetiooa altowed pa permit. • Iiikilding1PaaddiELGPatoilApp dog (film /ro M0.4015T(IU0S1COMIWDB • 14 d miaow cc 91;91 tZ LO-IOZ • • () 'f-at -o 1 =a=-vo 9 c - Ow Edyfie �T • Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No: H ao 1 3-- oU( U CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑ Routed Plans: Original Plan Submittal Date: Wad/ y 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact at 503 -718- or _ @tigard- or.gov) CJ Zoningase =. • �ame T� Setbacks: /f ront �� Rear / S Side ,5 Street Side l5 GarageZ a fi Maximum Buildin ii ht r ?t2 Actual Building Height > Z•a e ❑ ual Cleara B Easements Cep q 9 /9 ❑ Sensitive Lands Type: Notes: Original Plan: Approved Not Approved ❑ Date: ID Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) Actual Slope: Notes: Original Plan: Approved Not Approved ❑ Date: / a 5 1 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 jef City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov) ❑ Street Trees ❑ Protected Trees Notes: Original Plan: Approved Not Approved ❑ Date: fO D- 7 1A,----' Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes K .,. 0 ' i ,,. ' . '� .� Date Routed to Building: ___g ,. . 1 . •• • or • Page 2 of 2 • FOR OFFICE USE ONLY — SITE ADDRESS: 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. City of Tigard • .COMMUNITY- DEVELOPMENT DEPARTMENT IN . ' Transmittal L Letter "r I c; n is D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED .� JUL 12 2012 FROM: >9� `� CLTYOFTIGARD COMPANY: o BUILDING DIVISION PHONE: � \ d?7 - 9 7G _ /$ // B . RE: 11`(�ab('1� —OO/ go �/� dW �Ck (Site Address) (Permit Number) U (Project name subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: [ Copies: I Description: I Copies: 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. . Othe . plain): / ,� . MARKS: ...e." _ .J �Ltal-P —C k FOR OFFI E USE ONLY Routed to Permit Team__ ician• Date: 7( Iz Initial! Fees Due: ❑ Yes Rlqo Fee Description: Amount Due: $ , $ $ $ Special _ Instructions: - Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1: \Building\ Forms \TransmittalLetter- Revisions.doc 05/25/2012 iiii City of Tigard Address & Commerc Su Application TIGARD Addresses and suite numbers are assigned by the City ofTigard. Once a new address /suite is issued, the City notifies 911, USPS, Washington County and various utility providers. This does not change any account information or replace a "change of address" form. Directions To Submit Form / Fill in form / Via email: pauli @tigard- or.gov Attach Site Map or Suite Layout Map (see below) / By fax: 503- 684 -8840 / Fees will be charged when new address is assigned / In person: Permit Center Building Counter (13125 SW Hall Blvd., Tigard, OR) Fees: Do not pay when you submit form City of Tigard Addressing Contact: / Per address $50 Paul Izatt, Public Works ■ Per suite $50 pauli @tigard- or.gov 1 Suite or address to be retired — no charge 503 - 718 -2589 1 Re- activating suites in our system — no charge i REQUIRED Attach Site Map or Suite Layout Map / For Site Maps — show location of building on lot, front entrance & location of driveway along street / For Suite maps — show the locations of current active suites, new suites and suites to be retired Site Information Parcel Number or Current Address: 9�0o S C L,�od f T tD OE 974;3 (f Residential Property - OR - ❑ Commercial Property Building Name (if applicable): Is this property currently in the Land Use process (i.e. partition, site development review)? El Yes ❑ No Contact Information Contact Person: Qe0 /eV ez / r "V Property Management Company (if applicable): Ot1 h e v' Phone: ( 2, 3 ) 9 7O -1d' // Email: I e 9c...g ca & a-C-e-e-A- j?..A.44449 - 1.4-4%-< e VOFS /PoihOC Waks /Address AppEcaOOn Form For more information, please visit :mom tigard- or:gov ... . . . . ...... ..... ... g in WIPP n i Ep ...., i 4 ,••,-r1 1 . J 6 N 2 2 :ti tt ;,, ;twin , 352 — — • • I . CI i 1' Oi"` ... ___. ..._... ... ..... ... i 1 ! . let -.• •UP`DIAG r l h in f t.. IP F.--- f DR, 4 ■4; AY NI . I — . . i tk 1 . i i 1 i 4-f ot-'3e• , b 0 - I • i . . , • /Ai .. -Net . • • I . co .. _ o . ...__ . . : ... . I . . • . • , ...... j . I .....• i 3-6 . — . 1 • . • ; t 3 ; • . . I. Elsr ; 1 - I DECK .1 P I— — — —1 6 • . if ._ ......• __ ..______ .....•. — _ — ----•--- • ----••- . — _ .. . .. ... _...._. _ .. __.• ... .. ... _ 0• .. SCALE I . . . — — I OW . .384— 3S5 G — I ■ SITE PLAN 9200 SW EDGEWOOD, TIGARD, OR 97223 GEORGE TENY i . .._ .... ...... .._.___ _ _.. _._ .. _ .-.. -. i . . Ti • ard New Address Assi • nment -9265 9085 IN _ T I G AR.D ; EDGEWOOD $T 9210 13778 9270 it V 13794 ; 9160 Z i „9200 V 13812 9204 9190 11111111 ' 1111 10 13895 :MI I EW ADDRESS ASSIGNED i' lease correct your records on: i'arcel2S102DC04900 L y200 SW EDGEWOOD ST (Existing) x204 SW EDGEWOOD ST (New Additional Address) II r ip Code 97223 ■ rr .r • MQSIItlI • ' 'it• , .. 1 1 .A... !ard- or.!ov �• - -, Oil 1_,4 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9204 SW EDGEWOOD ST, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical final 06/19/2013 00:00 MST2012-00140 PASS Violation Summary: Inspector Contractor