Permit C ITY O F T�G�RD MASTER PERMIT
PERMIT #: MST2005 -00140
11(16. DEVELOPMENT SERVICES DATE ISSUED: 5/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134CB-00500
SITE ADDRESS: 12185 SW SUMMER ST ZONING: R -4.5 .
SUBDIVISION: SUMMER HILLS PARK LOT: 003 JURISDICTION: TIG
Project Description: 664 square foot addition and remodel.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 664 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 514 DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 664 st 50,000.00 REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 1
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
GAS FURN >=100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 1 0 - 200 amp: W /SVC OR FDR: . 7 , PUMP /IRRIGATION: PER INSPECTION:
•
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 0 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 0 SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601samps•1000v: MINOR LABEL:
1000• amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC/FOR >'225 A.: > 600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL B SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
ERIK WILBUR SIERRA NORTHWEST, LLC applicable laws. All work will be done in accordance with approved
12185 SW SUMMER ST 7000 SW YARNS ST plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97223 TIGARD, OR 97223 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in
OAR 952- 001 -0010 through 952 - 001 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246 -6699
Phone: 503 -579 -8929 Phone: 503- 740 -7340 or 1 -800- 332 -2344.
Reg #: LIC 163120
TOTAL FEES: $ 1,236.17
REQUIRED ITEMS AND REPORTS
Issued By : l:27 7/ Permittee Signature :
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
. 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.
Building Permit Application' 1 FOR OFFICE USE ONLY
City of Tigard C I` V I w Date/By: Received y / q 6, I Permit No.:1 �� T V
13125 SW Hall Blvd., Tigard, OR 97223 C . Plan Review �Ni`�
Phone: 503.639.4171 Fax: 503.598.1960 ��a _ Date/By: (nisi S v a 5
Other Permit:
� I
Inspection Line: 503.639.4175 ems. Date Ready/By: Ja ' 0 See Attached Checklist for
Internet: www.ci.tigard.or.us APR 19 200 Notified/Method: � Supplemental Information
TYPE `4F R bRK TIGARC REQUIRED DATA: 1- AND 2- FAMILY DWELLING
BUILQ1,NG DI tion m
❑ New construction Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
O Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
x i 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ JV / DM ,Do
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 121 8S St.x..) New M S i New dwelling area: c square feet
City/State /ZIP: (i1 6,-44Z_ i 0 9 "1 - 2 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: AD.01 -`t 0,1 N) Covered porch area: square feet
Cross street/directions to job site: 121si $ S,N,„Ii Mi,l Deck area: square feet
W1 }t_ (J07 e.16-1-1 f 0 12_1 liz. j - T c To Su,UMEA... Si' Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
/_ `I � DESCRIPTION OF WORK work indicated on this application.
(0 & ' S /1-499 i T i t)0 . E, L -Cr
t -6 . 4.11 -c-jt Valuation: $
L1 %./k Ns - S P �L Existing building area: square feet
New building area: square feet
'g PROPERTY OWNER ❑ TENANT Number of stories:
Name: \Z),L i ,,, j l v Type of construction:
Address: II_ k S S S Su M ,M L S.- Occupancy groups:
City/State /ZIP: -- I b c, /Z 9 7 z:2 Existing:
Phone: (g,) 5 11_ e9 Z9 Fax: ( )) New:
`,APPLICANT IS, ONTACT PERSON NOTICE
Business name: S i f _44_, t - 04 rtJ tN (— j .. 4 _- ; .._ All contractors and subcontractors are required to be
Contact name: 11 licensed with the Oregon Construction Contractors Board
i L J 1 V under ORS 701 and may be required to be licensed in the
Address: - 1 rr0� S V 42 S 1 - jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
`TIG C) C3 f t 7 223 apply: /I
Phone: ( l . 4 3 / ) - 7 ti 1 g 4 t : F a x : : ( ) S L ' - P/YvIT . -.,/ 70 .5/()
E -mail: nielvta` Q- L'l e..1 ec..awA �¢,,/. 3U(7 •U
CONTRACTOR 3 -7• l 12
Business name: >^ p t ,,y �- L (LC_ P E MIT
Si IZ"2 `'"� j� �-Tc� BUILDING PERMIT FEES*
Address: -7 C-c� C2.-1-.., vvvz-N S ,T Please refer to fee schedule.
City/State /ZIP: • t Gi a_a_O 6 n -7'1 L 23
( Fees due upon application
Phone: ( S'T,2) - 74{ V 7 3 i_I. 0 I Fax: ( )
Amount received
CCB lic.: UD 3 k Zu Z).c - 0
g Date received:
Authorized signature: 6 _ _ .__ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: i 1 , i j i ea, A s ; l ) i �z..-- Date: T`l / 13/a-• * Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \Pennits\BUP- PermitApp.doc 12/03 440.4613T(11/02 /COM/WEB)
One- and Two - Family Dwelling . '
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received PermitNo.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Phone: 503.639.4171 Fax: 503.598.1960 / Associated permits:
t ❑ Electrical ❑ Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175 ■ eT l il
Internet: www.ci.tigard.or.us � �.. ❑ Other:
THE 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: ❑ El
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 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ El
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.
v 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size El ❑ ❑
and location.
J 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, El ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
1 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. _
.1 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- El ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards. _ _
J 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."
4 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists El ❑ ❑
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.
v 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 applicable to the .roject under review.
JURISDICTIONAL SPECIFICS
Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". CI ❑
4 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
5 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 tree protection measures as required by conditions 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 \Pemvts\BUP- RES- PermitApp.doc 2
Plumbing Permit Appli j IV 1 FOR OFFICE USE ONLY
City of Tigard V Receive Old Permit No.: � (4
13125 SW Hall Blvd., Tigard, OR 97223 R Q ' ��
Phone: 503.639.4171 Fax: 503.598.1960 Np 1 g i tip e! I Plan Review
'� ti Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 f ,a i ,. Date Ready/By: i ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF Tr, - Notified/Method: / �� Supplemental Information
TYPE OTl RIERNG LVISI FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
yr Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 •
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: It. % gs-- 5,,,,., so .4.1 AA g: di- s-r Catch basin or area drain 16.60
City/State /ZIP: U 1 G t& 41 Z t 5 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
�0 1 N Manufactured home utilities 110.00
Cross street/directions to job site: 0...t57 4 50 ,,,,,,4 Manholes 16.60
- ri4.tG.(c o>itu-NIT T 1 RKi.(I(T 43 A 11.1 Tr. Rain drain connector 16.60
Lift 6A T I ' 4 sa .ii "t L ST. 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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
(i&o 4 Sr A-DD 1'(10 1 me C.1 Tc I1(C.)J Backwater valve 16.60
`ZI�t 4 V % J 14) 4- Ate_ Clothes washer 16.60
Dishwasher 1 16.60
lia PROPERTY OWNER I ❑ TENANT -
Drinking fountain 16.60
Ejectors/sump 16.60
Name: 5/... ‘ c_ 1.�� i 1 _ Qv Expansion tank 16.60
Address: Va k E s s...a s O M 114 CA SI. T Fixture/sewer cap 16.60
City/State /ZIP: - G-, a...O 6(t_ 172-2-3 Floor drain/floor sink/hub 16.60
Phone: (c )) T 71 - $g 2.I Fax: ( ) /,A. Garbage disposal . ( 16.60
pa APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker j 16.60
Business name: 51 r ,2_,L, 4 ? t TI1 I,Jc. S'T (.l-c... Interceptor /grease trap 16.60
Contact name: ij 1 L V ` Medical gas (value: $ ) Page 2
Address: 7DOC Sa v letaM S ST Primer 16.60
City/State/ZIP: "Tic, A42.4) 6 of ^? Z2'3 Roof drain (commercial) 16.60
'rA 1 � Sink/basin / lavatory 1 16.60
Phone: (9 740 ' 1 3 ` 0 Fax :: (g.3) -" / $ ' 775
1 r. r 1 1 Tub /shower /shower pan 16.60
E -mail: V1 lc," A- 1 q , C_.c....,
Urinal 16.60
•
CONTRACTOR Water closet 16.60
Business name: i .t q �� c \ , r ,...., .4- ji jr _ 4 �.....) Water heater 16.60
Address: ':' 1.�, *,Z,1y / Other:
`�'� A �� � t c• ff\ / / / / Subtotal
, :,
City/State /ZIP: ' v -\ (y
Minimum permit fee: $72.50
Phone: ( / Fax ') Residential backflow minimum permit fee: $36.25
�-7 T
CCB Lie.: Plumbing Lie. no.: / Plan review (25% of permit fee)
- �1 - State surcharge (8% of permit fee)
r+ _
Authorized signature: TOTAL PERMIT FEE 7 g. 3 v
Print name:, eV( L t4,4-E..
Date: `9/Ar` 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.
i:\Build PermitApp.doc 12/03 4404616T(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 - I °' 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
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.
•
. , - _ 1. , 5 J
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed /,, • • r 1
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixt work: • •
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool `
Car Wash -Each Stall ; - `
-Drive Thru -
Cuspidor/Water Aspirator ' '
Dishwasher - Commercial . .
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink -'2"
3„ . •
- 4"
Car Wash Drain ••
Garbage - Domestic I ' t
Disposal - Commercial *Note: , If the fixture work under, this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach/Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase Must be 'paid before the
Rec. Vehicle Dump Station plumbing permit can be issued. .
Shower -Gang
-Stall
Sink - Bar/Lavatory -
Quantity Total. ' "
- Bradley • Isometric or riser is requiredif fixture quantity
- Commercial
- Service , total is >9. - , . -
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required it fixture quantity total is >9.
Urinal
Other Fixtures:
•
i:l Building %PermitslPLM- PermitApp.doc 3/03
Electrical Permit Application FOR OFFICE USE ONLY
of Tigard ,`
Received /
City R rr v Date /By: �y Q S Permit No.: ■�� `�Q
13125 SW Hall Blvd., Tigard, OR 97223 ! l� v � Plan Review
Phone: 503.639.4171 Fax: 503.98.1960 1 Date /By: Other Permit:
Inspection Line: 503.639.4175 r. �11' e e l I D a te Ready /By: Ed See Page 2 for
Internet: www.ci.tigard.or.us APR • ' No[ifed/Me f eg> Supplemental Information
TYPE OF37176I I IIGARD PLAN REVIEW
❑ New construction ❑ Addition /BIAP 1ptmeSION Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility ❑Other:
Job no.: J_Qb site address: I ZI 8 S"" S,,p so /4# Eh. S T Submit 2 sets of plans with any of the above.
City/State /ZIP: c 641.0 e2 ., '7 2-7-3 The above arc not applicable to temporary construction service.
l FEE* SCHEDULE
Suite/bldg. /apt: no.: Project name:
Description I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: wit /tout service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit .- 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax. : ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: --D�,�,- 6) - c_ V�
A \ ' b*-- Each additional inspection over allowable in any of the above
Address:
qv o 9 v\ E, ( D\ ► S S Per inspection 62.50
City /State /ZIP: — .)f\ q ? .z„z 0 Investigation per hour (1 hr min) 62.50
Phone: ( ) 7 7 / fC > 7 Fax: ( ) 77y —/ p y‘ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: Electrical Lie.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE
Authorized signature: d C c>.........___.____174)
� This permit application expires if a permit is not obtained within 180
f/ p days after it has been accepted as complete
- Print name:" / `i ( L lV' /�_ Date: e / / I 05 -- • Fee methodology set by Tri- County Building Industry Service Board
//
•• Number of inspections per permit allowed.
i:\ Building \Permits,Gl.C- PcrntiiApp.doc 12/03 440451 T(10 /02 /COM /WED
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:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ 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 •
i:\ fuildin0 )Pcrmits)ELC•PcrmitApp.doc 04/03
Mechanical Permit Application • FOR OFFICE USE ONLY
City bf Tigard ii r- _ w (l E � D Da /B Y : ii O✓ ` Permit No.: ,`'1 ll a T(
13125 SW Hall Blvd., Tigard, OR 97223 L Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
Inspection Line: 503.639.4175 A PR �� � � n`I I Date Read /B I ® See Page 1 Ready /By: � e 2 for
g
Internet: www.ci.tigard.or.us Notified/Method: ! ` CA.• Supplemental Information
CITY OF TIGAR
TYPE 8UW I4G D%VISIO* COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- 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
(Mb site address: Air conditioning or heat pump
C 12� e s' s „, SC)µ s T (requires site plan showing placement) 14.00
t City /State /ZIPa T G ,4- 4 6 -. c . � Z 23 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct. suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
ht _D "boot 14a2.v- c-eat.. D4.6_.0 SPr_G,.. Flue vent for water heater or gas
1 fireplace 10.00
1 SOIL .0C. 1 6:— Kd Log lighter (gas) 10.00
J P To Si k rit.A.. 9g S Pkc-f- Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent ' 10.00
❑ PROPERTY OWNER ❑ TENANT Other 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms.
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: _ 10.00
Business name:
Fuel piping
Contact name: 55.40 for first four; $1.00 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: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax:( )
Plan review (25% of permit fee) _
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE ` . 50
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: .� 7 Date: Y / /9 /Q S' • Fee methodology set by Tri- County Building Industry Service Board
Mechanical Permit Application - City of Tigard •
Page . 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to S2,000.00 Minimum fee $72.50 •
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction •
thereof, to and including $5,000.00.
S5,00I.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00. •
$50,001.00 to S100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
• $100,000.00.
$ 100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
•
i:\ Building \Permits \MEC- PcrmitApp.doc 12/03 2
Apr.18. 2005 9 :03AM,. ,CLEAN WATER SERVICES 503 6814439 ;,,., No .6340 P. 1 ,
File N►rmbcr D
MAR 0 9 2004 r Clcan Services on. c.,.....01„,,,„, ks rri,.nr. - s tove Area Pre$cr Wing A ss s ent ey -- � -_--- - -_ -_- AP 19 2005
'.--T
Jurisdiction 't 19. & r _ _ Date 3 to �, � , . OF TIGARD
� 1 � t -
Map & Tax Lot - c. - 00 , Owner . _ i - �_. r 4�,u��V�:
s N
Site Address :5 • e e -
i.r . 0 - 3 Contact Y2-1 $S Sw `ALL -vr, rr4 \-
Proposed Activity '' . ,, ,, a , -, • ._ Address � gt-vd+ DR- ert 7.3
�l
. Cift n Pli-`3j mi
S c -4:1). hone 5o3.519. CA ZM
F04 5 D3 . ( C S S - 9 '3-
' Official use only below this line
Y N NA Y N NA
®❑ rr - �� Sensitive Area Com osite Map Stormwater Infrastructure maps
I—I Map# /5/t4.) ❑ ❑ QS# 1.4t /7
❑ ❑ V Locally adopted studies or maps ❑ ❑ O t her
Specify Specify _veal. a er;al !Agra
Based on a review of the above Information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 04 -9:
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If. Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
(0 Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
• ❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments: l
/,�i1.srr/ oh trvi e I 2.00 6,4. e :6,1 ®Le,t'o Rol ehr ;kJ ly $ rkf:T:ve
ex V e4 5 do hnT .peas. •ro e. A: Sr- 1.../;74.'s. moo fe . r 0 o e rA Aire.
Reviewed By: U!' A. --vim. __ Date: ,3/i‘A y
Returned to Applicant
Mail Fin / 4 Cnunter
Post -it° Fax Note 7671 Date / /gfo� . / Date - 3//g y 1;Y_a6
CodDcpt. . ►A1. / Y & O'0•4 Co. ( 8 / M w 3 .
Phone n Phone # 50 3 ,, 6 iv- 3
Fax #5 2 . 570 0, 7 8 Fax #
CITY OF TIGARD \-
BUILDING DIVISION PERMIT #: MST2005 -00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2005
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 . P' I I
INSPECTION WORKSHEET FOR DATE: 9/14/2005 TIME: 7 :09AM PAGE: 41
SITE ADDRESS: 12185 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 003 TYPE OF USE:
PROJECT NAME: WILBUR
DESCRIPTION: 664 square foot addition and remodel. 7- 8-2005 Add 5 branch circuits. •
OWNER: WILBUR, ERIK PHONE #: 603-57 ; • •
CONTRACTOR: SIERRA NORTHWEST, LLC PHONE #: i 740.7 41
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 015659 -01 503-740-7340 N
Corrections /Comments /Instructions:
1 / AL _ ..r b , mr
iktn a gerio-dAez2:e_e el L.,,t.t,' fze.tr
- 249 A d .c s-c 101,- D LA-c
.s -c YJ- s
fiet— a , �, � ade_ Gam l '� / 'e
a 4 yta., ,� ate+ ,
C)
/ Ass ❑ PARTI ' APPROVAL 11] CANCEL ❑ NO ACCESS
IL ❑ C' // FO IN TI ❑ ADDITIONAL FEES ASSESSED
Inspector: Date R l 4 0 Phone #: (503) 718
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005.00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/20U I
Phone: (503) 639 -4171 � � I l
Inspection Requests (24 Hrs.): (503) 639 -4175 . p I I..
INSPECTION WORKSHEET FOR DATE: 9/12/2005 TIME: 7:04AM PAGE: 54
SITE ADDRESS: 12185 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 003 TYPE OF USE:
PROJECT NAME: WILBUR
DESCRIPTION: 664 square foot addition and remodel. 7- 8-2005 Add 5 branch circuits.
OWNER: WILBUR, ERIK PHONE #: 503579 - 8929
CONTRACTOR: SIERRA NORTHWEST, LLC PHONE #: 503 -740 -7340
Inspection Request Scheduled For: Date: 9/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 015401 -01 503-515.2922 Y
Corrections /Comments/ Instructions:
sPs 1 ( �4. A Mu w4Lh K oA - EIL isaec_. V\ (,l.z4,
C k 1 tot-rdstereit_. - (iti sio ite eibk___
1 e ci* �o& 3 10S `10(5 41 cp rt OILE. .
----) PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1! FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / , -" Date: 9 Phone #: (503) 718- AiL__
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005-00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2005
Phone: (503) 639 -4171 �..�11 j �, fi
Inspection Requests (24 Hrs.): (503) 639 -4175 .� , - P:_..
INSPECTION WORKSHEET FOR DATE: 9/12/2005 TIME: 7 :04AM PAGE: 30
SITE ADDRESS: 12185 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 003 TYPE OF USE:
1 PROJECT NAME: WWILBUR
DESCRIPTION: 664 square foot addition and remodel. 7- 8-2005 Add 5 branch circuits.
OWNER: ILBUR, ERIK PHONE #: 503.579.8929
CONTRACTOR: SIERRA NORTHWEST, LLC PHONE #: 503-740-7340
Inspection Request Scheduled For: Date: 9/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 015413 -01 5 503 -740 -7340 N
Corrections/Comments/Instructions:
,71Nrarillill _ �_�.�
for
,, /
( a17)
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ' /° Date: q//),ied Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST20000140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2006
Phone: (503) 639 -4171 At
Inspection Requests (24 Hrs.): (503) 639 -4175 P 'I L.
q________
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 13
SITE ADDRESS: 12185 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 003 TYPE OF USE:
PROJECT NAME: WILBUR
DESCRIPTION: 664 square foot addition and remodel. 7- 8-2005 Add 5 branch circuits.
OWNER: WILBUR. ERIK PHONE #: 503- 579-8929
CONTRACTOR: SIERRA NORTHWEST, LLC PHONE #: 503-740-7340
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 015188 -01 503 - 740 -7340 N
Corrections /Comments /Instructions:
&PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED c p
Inspector: '11 - Date: G i/o b( Phone #: (503) 718-