Permit CITY OF TIGARD MASTER PERMIT
IIII I: COMMUNITY DEVELOPMENT Permit#; MST2012 -00204
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/21/2012
Parcel: 1 S134DB01700
Jurisdiction: Tigard
Site address: 11200 SW 115TH AVE
Subdivision: WINTERS ADDITION Lot: 6
Project: Hufford
Project Description: Converting 528 sq ft garage into family room, bedroom and bath.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 528 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: 528 sf Value: $34,045.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 1 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
Other Fixtures: 0
Drywell- Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1
Heat Pump: N Hoods: 0 Other Units: 0
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'l 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R -3 528
Owner: Contractor:
HUFFORD, ARLY R & ANNETTE J OWNER Required Items and Reports (Conditions)
11200 SW 115TH AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $1,920.43
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 '• . • • . • - with approved plans. This permit will expire if work is not started within 180 days of issuance, or ' • is suspends• •r ore the 180
days. • ENTION: Oreg• • law r- quires you to follow the rules adopted by the Oregon Utility Notification Cen = . T •se • -s - / s= in t • -1
95. 001 -0010 through OAR 95. • -0• • • ou may obtain a copy of the rules or direct questions to OUNC by calling 503.23 987 or 1i • • • .
I sued By: / / , , a „,/
1 L41 1 -Ill . i Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection • / ° /
This permit card shall be kept In a conspicuous place on the Job site until completlo f the project.
Approved plans are required on the Job site at the time of each inspe on.
Building Permit Application
• Residential :
5 ; 0 7 3 FOR OFFICE USE ONLY
' '' ���,,,,,, "Received 114 City of Tigard AUG Date/B : i Permit No. 7;2 of fever
° 13125 SW Hall Blvd., Tigard,OR 97223 G 0 1 2012 plan Review jt
0 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Ir► LL� Other Permit:
T I G A It D
Inspection Line: 503.639 �`� aV� Date Read _ f� , Ju ® See Pa e 2 for
Internet: www.tigard- or.gov ° " " �� �` ' Notified/Method: �J �O ' ��' 'Ys► g
a °`P 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.
�'1- and 2-family dwelling Valuation: $ 3� n 4
y g ❑ CommerciaUindusVial � --r,�
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: t
JOB SITE INFORMATION AND LOCATION Total number of floors:
le Job site address: ( I 1 S L,J i 19 Ave New dwelling area: S Z c2 square feet
* City /State /ZIP: 5 eAr Q iZ q`v 2 , Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area square feet
1 n
Cross street/directions to job site: (1 ( E ) "' .d- N ort'h DAce Deck area: square feet
Other structure area: „square feet
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
CO , 7 DESCRIPTION OF WORK work indicated on this application.
Valuation: $
CiA.rceov- CI axmo i f‘ I-0 Fa-H: ( R M
Gtel d; n W ► t n A. 13 a.T L [14 4- beak (� Existing building area square feet
J New building area: square feet
ig PROPERTY OWNER ❑ TENANT Number of stories:
l c Name: AAA e'it a li L1/4 C e, rk Type of construction:
Address: it 1-00 5L) 1 i91-. A e- Occupancy groups:
City/State /ZIP: v 1 - 1 q t q J 0 R r 1..). 2 ) Existing:
Phone: (911) 22 24 S 4 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:
(Please refer to fee schedule
Structural plan review fee (or deposit):
Contact name:
FLS plan review fee (if applicable):
Address:
Total fees due upon application:
City /State /ZIP:
Amount received: 3 6 6 , 7v
Phone: ( ) Fax:: ( )
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: 611 Of (?/ Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City /State /ZIP: Permit Fee (includes plan review $180.00
and administrative fees):
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB tic.: ■ ! Total fee due upon application: $201.60
Authorized signature: • ■its ��� /' This permit application expires if a permit is not obtained
i within 180 days after it has been accepted as complete.
"Fee methodology set by Tri County Building Industry
Print name: r /M'AT���� Date:
/ / / /ice / Service Board.
I:\ Building \Permits\BUP - RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)
Building Permit Application Checklist ' ' •
One- and Two - Family Dwelling FOR OFFICE 1161'. ONLY
City of Tigard Received
Permit No.:
II Date/By:
n 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
C :. Phone: 503.718.2439 Fax: 503.598.1960
I' I G n R D 24 Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
TI -IE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 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 . El ❑ ❑
6 Sewer permit. ' El ❑ ❑
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.
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. ❑ ❑ El
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 ❑ ❑ El
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.
2() Manufactured floor /roof truss design details. ❑ ❑ El
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 Ion 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. ❑ ❑ El
25 Building plans shall not contain red lines or tape - ons. "Mirrored" building plans will not be accepted. ❑ El ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ El
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 ❑ ❑ El
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.
1:\ Building \Permits\BUP - RESPermitApp.doc 02/24/2011 440 -4613T(II /02 /COM/WEB)
`1
s _ .
Plumbing Permit Application
1-7 • prpciur,r) R ec eived FOR OFFICE USE ONLY City of Tigard Permit ermit N �7 /� 4 4o 0 /
II 13125 SW Hall Blvd., Tigard, OR 97223 AUG O 1 2012 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
TI G A R D Inspection Line: 503.639 Date Rea B: lads: RI See Page 2 for
Internet: www.tigard or.gov ry
V � ' � �r "� ' � � y g
III Inic,ntri ill p,zt.aoa►- Notified/Method: Supplemental Information
TYPE OF WORI�1 'I"t r . "c-'1"1 d FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Pi Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
el- 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 builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: It 2 •- • °° J Li l l5 0% AV e- Catch basin or area drain 18.76
Drywell, leach line, or trench drain
City/State /ZIP: Ti a a t t c } z2 Footing 3
Footing drain (no. linear ft.: ) Page agc 2 2.
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: S'' o(- Oak * tt,f■ Manholes 18.76
Rain 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
a Clothes washer 25.02
a C1 u r 13 ° r f�. 1 n A c v Q t 4 d • 1 OA Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
Z. PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: !''fi e C tk ts6 Fixture /scwcr cap 25.02
Address: 1 ‘ 2 00 1,,) 1' S +h A ..e.. Floor drain /floor sink/hub 25.
Garbage disposal 25.02
City/State /ZIP: Ti ot o.. O� Z 2
C k - - S Hose bib 25.02
r -
Phone: ( 'l ) L .,. .2y Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory / lc' . 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet X 25.02
Water heater 37.52
Business name: OW /0 Ea- Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: Plumbin • ic. no.: Plan review (25% of permit fee)
1 � ���-_ _ State surcharge (12% of permit fee)
Authorized signatur � ��� C
`��` ��Ar�� TOTAL PERMIT FEE
Print na � WWIRT • V . / Date: ' mv� This permit application expires if a permit is not obtained within 180 days
tL� a ® _ after it has been accepted as complete.
/ *Fee methodology set by Tri -County Building Industry Service Board.
I: \Building\Permits\PLMU- PermitApp.doc 10/01/09 4404616T(I0 /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' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,200 - $233.20
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
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath -
- Tub /Sh as defined in OAR918- 780 0040.
/Whirlpool
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 an 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.
-4"
Car Wash Drain
Garbage - Domestic
Disposal . - Commercial
Industrial Comments regarding fixture work:
Ice MachiRefrig. 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
- Service 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 plumbing permit can be issued.
Water Extractor
Water Closet - Toilet
Urinal _
Other Fixtures:
I:\ Building \Permits\PLM- PermitApp.doc 2
., Mechanical Permit Applicatio X s r
IY)R O1 I IC USE ONE)
15 4 , i
j r Received lif lig City of Tigard Date/By: Permit N. , , /a — O0o20
q 13125 SW Hall Blvd., Tigard, OR 97223 AUG 0 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 2� i Z Date/By: Other Permit:
I I G n K D Inspection Line: 503.639 �- Date Ready/By: y: 3uris: See Page 2 for
Internet: www.tigard or.gov ' �� 1 `� ��� Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
,� Mechanical permit fees•" arc based on the value of the work
❑ New construction Z 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*
Z1 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:
W , A Air conditioning
Job site address: I' —LC) 4 S W ! (S +� r `V e 75
(requires site plan showing placement) 46.
City/State /ZIP: T t � 0 K \T 'ZZ Furnace 100,000 BTU (ducts/vents) 46.75
a Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: P roject name: Heat pump
J 1 \5 '��"+ J V o � U l` G. tc Duct site plan showing placement) 61.06
Cross street/directions to job site: worrk 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
a /� j� Gas fireplace/insert 33.39
d j r r l > s /"` r " t P.XL.0,, .S'- ci Flue vent for water heater or gas
0 I G 6l o k; -l` O^. 11•--tot... Gar-0.0►� 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: Ancw ` G 4 \'O4 Environmental exhaust and ventilation:
Address: l' ?� , � Ste— ((S IA ' Ao e- Range hood/other kitchen
e equipment 33.39
City /State /ZIP:r OR R.9- ) Clothes dryer exhaust I 33.39
Single -duct exhaust (bathrooms,
Phone: ( l) 77.1 _WI Fax: ( ) toilet compartments, utility rooms) I 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: D It J /■ t2 Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
j � ' / � ' � This permit application expires if a permit is not obtained within 180
Authorized sig ure: � .,„ — / / / days after it has been accepted as complete.
Print name A ��� ` � �� Dat ,r • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PeimitApp.doc 03/07/12 440-4617T(I1 /12/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee: 1
$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 Applicatior4r 1 FOR OFFICE USE ONLY
City of Tigard f l • � *.Jd' , D Received
Date/By: Permit No/ ?2d /a2 — �o2 L/
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
` C Phone: 503.718.2439 Fax: 503.598.19AU G 0 1 2012 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: turfs: Hi See Page 2 for
l' I G A R D
Internet: www.tigard
CITY O GAF1DJ Ci T YCF Zif? f1 t 69D Notified/Method: Supplemental Information
`�;•' ,;,.6c... ff- •"•tSa AI PLAN REVIEW
T YPE OF .;:V ll�li:
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construct ion , Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
� less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
,
�J I and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: ' t,"� Q S i� ti S t1 Al, t- 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: + r l ❑Health -care facilities.
0 Supply voltage for more than
� a c Ct 2 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
ii C �
Cross street/directions to job site: ! 1 l }� �.. o ' -k p /q _ Description I Qty. I Fee. I Total I •
" "� FEE SCHEDULE
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
014 ; 6 „ """ i - „ e 1, av . I L 1, t ` f � residential (with above sq. ft.)
11 �� t M 3 Services or feeders installation, alteration, and/or relocation
1 b a `t 1b 0 200 amps or less 100.70 2
0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Ann e d 401 amps to 600 amps 200.34 2
D(` 601 amps to 1,000 amps 301.04 2
Address: t t zoo 'S W 1 6i" A Over 1,000 amps or volts 552.26 2
City/State /ZIP:T` a4 02 R9— Z2. Temporary services or feeders installation, alteration, and /or
t relocation
Phone: Aril) —2 1 — 2,454 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, accordi g r O' S 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
7' Branch circuits – new, alteration, or extension, per panel
Owner signature: , (�..,_, ..J .•L, � i , t s, Date: Z y L A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PE ON /// above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit A 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: / 3 ! . 1 f'� panel, alteration, or extension. Page 2 2
(J ( tJ Each additional inspection over allowable in any of the above .
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal:
Plan review (25% of permit fee):
Print name: Date: / State surcharge (12% of permit fee):
'� �j TOTAL PERMIT FEE:
Authorized sig , " l%
. /�� 1 This permit application expires if a permit is not obtained within 180
Print name ����� y„ ate: ,,M7 /11 days after it has been accepted as complete.
— /� I �� L� ti �' Number of inspections allowed per permit.
1:\ Building \Permits\ELC•PermitApp.doc 07/01/10 440 -4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2•- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
' COMMERCIAL WORK ONLY: j
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC- PermitApp.doc 07/01/10
W Mil
'A
Property Owner Statement AUG 01 2012
Regarding Construction Responsibilities OFTI CARD
Oregon Law requires residential construction permit applicants who are not license h ey DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building,.electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be • •
licensed with the Construction Contractors Board.
or
1 ,6 I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand theInformation Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
.1601 0
rint Name of Permit Applicant
Signature of Permit Appli : nt / , Date .
Permit #: n.57 O Je — /)00 0
Address: //a0U SA Ns- es-
ti
A2 A 02 77 ;,- 3
•
Issued b Date: Of /' C1= •
This Copy for Permit Offices
1,11 o ° Building Division
Development Code Provision Review
T i c n R Residential Projects
Building Permit No: ra 2O/) ' 00 02O Y
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans: /
Original Plan Submittal Date: efX// 02- AW
1st Revision Submittal Date: ❑ Site Plan Only
2 " 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 - Z'-t3Y or fc I A @tigard - or.gov)
Land Use Case No. Name
)J- Zoning I `(.s
p Setbacks:
Front 2 Rear r 5 Side Street Side /S Garage 20
•�7 Maximum Building Height 30 Actual Building Height
Er Visual Clearance itrH
J2 Easements nlye
Er Sensitive Lands Type: /V/
Notes: / " -� p
G6 /" A / vir.� o� r S/?e rya k >lf c Ap /l-, i/p..S/Ve61J7
Original Plan: Approved .EK Not Approved ❑ Date: ci 6 - 1 Z
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:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
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:
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 ❑ No ❑
Date Routed to Building:
Page 2 of 2