Permit Mechanical Permit Application ED , . FOR OFFICE USE ONLY
ip, Received Q
W Date/By: / 9 City Tigard CEO E D O Permit No.: �� 9 13125 S W Hall Blvd., Tigard, OR Plan Review
C • Phone: 503.639.4171 Fax: 503.5 8. D a l y . Other Permit:
TI G A R D Inspection Line: 503.639.4175 S E ® 2009 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov P Notified/Method: II Supplemental Information
TYPE OF OF TIGARD COMMERCIAL FEE * - SCHEDULE - USE CHECKLIST
``
R �� tt p`NG DIVISION Mechanical permit fees* are based on the value of the work
❑ New construction Addition /altCid11 n /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*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description
Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
In Air conditioning or heat pump
Job site address:
t4,9. 6, e J ` I (, ft,. p t_ (requires site plan showing placement) 14.00
City /State /ZIP: - 1 G pv V A R et .- , u Fumace 100,000 BTU (ducts /vents) 14.00
C Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Pro name: t4 ,, 1 ‘ t Gas heat pump 14.00
Cross street/directions to job site: Duct work a. 10.00 a 11'
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. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
� Gas fireplace 10.00
? 13 L S, e a- fd >o� -!, 0.rte 0 ,(- 't l C \< Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
I Chimney /liner /flue /vent 10.00
CS(PROPERTY OWNER ❑ TENANT
f Other 10.00
Name: 5 ^, 1461°<1 Environmental exhaust and ventilation
L 1 v ,p Range hood/other kitchen
Address:
L- ci ( L S. LA) \ \ L, Ttl l 1 -4 36 C 5 - equipment 10.00
City /State /ZIP: C � 61? Q‘4,-‘5-?`")q Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( , . . c . . , ; 0 t,,, ) :- C 1 II Fax: ( g,tj.) Log _ 1 .s -_) 5 toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
� Clothes dryer (gas)
Business name: �6(t.) Othe
Address: r � MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal ca1O -
Phone: ( ) Fax: ( ) Minimum permit fec ($72.50) - 11'a . .5 0
Plan review (25% of permit fee) 1 % t L 3
CCB tic.: State surcharge (12% of permit fee) g ,10
TOTAL PERMS n FEE � 3 0
Authorized signature: This permit application expires if a permit is not obtained within withi n 180
days after it has been accepted as complete.
Print name: C ■V l J kook( o ( S Date: - �^ h 1 ' Fee methodology set by Tri -County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 01/19/07 44046t7T(I1/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 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.
$5,001.00 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 $100,000.00 $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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2
V
Electrical Permit AppliFt J - - FOR - OFFICE - IJSE ONLY - -
R eceived / i
1E9
City of Tigard E"J / Permit No.: f
13125 SW Hall Blvd., Tigard,ORs9,?3 2009 Plan Review 4 I
Phone: 503.639.4171 Fax: 503 9S 9NO D ' Other Permit:
® Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: e Supplemental Information
TYP$��®IDIVISIO PLAN REVIEW
❑ New construction f, Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
❑ 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 ", 't - ", "1 - ",
Job no.: Job site address: 1 ` 1 1 \ L.D. ' P" t`J Six or or more. occupancy. P �r t? ❑ six or more residential units. ❑ Recreational vehicle arks.
City/State /ZIP: G •E''1 r ^`� (31-1 _ ❑ Health -care facilities. ❑ Supply voltage for more than
lJ 1 ❑ Hazardous locations. 600 volts nominal.
/
Suite/bldg. /apt. no.: Project name: (` l. 6 f Il ` �� ❑ Service or feeder 600 amps or more.
0 C FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
F: ,■ -(.6 S.L!,. f yki C D. of.- ).< (< residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
10 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
r 1 401 amps to 600 amps 160.60 2
Name:
`� U P �Z \ 4 5 601 amps to 1,000 amps 240.60 2
Address: 1 I.,.t c I to %A ) ( 6 - \ f L„ & L Over 1,000 amps or volts 454.65 2
City /State /ZIP:' ` G et Di 1— , \ I Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) 1 kt ,_ , L , e�' \ Fax: (S 03 ) L $ 4 .., 1k .. C 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, le , rept, or ex hange, cco ding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
1 Date: p , /' c Branch circuits — new, alteration, or extension, per panel
Owner signatu
_ ` V 1 A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: without service or feeder fee, 1 I 46.85 Li cis 2
first branch circuit
Address: Each add'l branch circuit 6.65 _ _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
` Signal circuit(s) or limited -
Business name: (D60A t7?a` energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour _ 73.75 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: p g en, Subtotal: Lt L,. lg S
Print name: Date:
Plan review (25% of permit fee): i \ t -1 1
State surcharge (12% of permit fee): S. (y
Authorized signature: TOTAL PERMIT FEE: (y , t S
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(II /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:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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: \Building\Permits\ELC- PermitApp.doc 03/23/06
Building Permit Application
Residential FOR OFFICE USE ONLY
ECE\\IE Received i
City of Tigard Date/By: el 07 �'j Permit No.: 5r 'ir,a1e0
:I CC CC ° 13125 SW Hall Blvd., Tigard, OR 97223 0 9 2._ 09
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 - ' Date/By: Other Permit:
T I G n R D
Inspection Line: g 0 . 4175
(IF T IG A RD Date Ready/�y; ® J ®See Page 2 for
Internet: www.ti ardor. ov C I f . „ � Notified/Met�. / Supplemental Info
WILDIN G 1
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
0 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the '
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial /industrial ®00
❑ Accessory building ❑ Multi - family Number of bedrooms: N IN
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
1 Job site address: , Lts ` L S 1,,3 \ k G1\ . c New dwelling area: a d � square feet
City/State /ZIP: 1 I G -A f 1 b y 1"� a �I Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: VA a I� 1 7‘1 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
• REQUIRED DATA: COMMERCIAL -USE CHECIQ.IST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
ax 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: $
r L. c► St , P( 22: 1 c, 4)1- ` -CSC_.
Existing building area: square feet
ilk A
New building area: square feet
PROPERTY OWNER ❑TENANT Number of stories:
Name: Q 0%) IA 0 se t� 1 t. I 5 Type of construction:
• Address: I (J C 1,,� 1' D l ` Q ' T►1 ��,� Ti; Occupancy groups: •
City/State /ZIP: T-� (o ,p�� Q a') a 7l� Existing:
Phone: ( 56 to B ( . '''') 1 Fax: (S b3) 6 $ LI L 4.519 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
-.Business name: All contractors and subcontractors are required to be
4-,
ontact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR
rcl. Business name: (...AD \ BUILDING PERMIT FEES*
VI 0 Address: (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): i
CCB lic.: Total fees due upon application: Sa 154
� Amount received:
Authorized signal This permit application expires if a permit is not obtained
�— I within 180 days after it has been accepted as complete.
Print name: G �. ` l"k.C.., INS p Date: 1 Q \ d * Fee methodology set by Tri -County Building Industry
V Service Board.
I:\Building\Perrnits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
C ity of Tigard R eceived Permit No.:
74 D ateBy:
a 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
C Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 ' ❑ Electric ❑ Plumbing ❑ Mechanical
TIGARD
Internet: www.tigard- or.gov ❑ 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: . ❑ ❑ ❑
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.
11 N. /plot plan drawn to scale. The plan must • • lot and building setback dimensions; property comer.elevations (if . ❑ ❑ .
t - = - more than a 4 -ft. elevatio i ' -nttal, plan must show contour lines at 2 -ft. intervals); location of easements
and drivewa ; .:._ • ._:..,y ructure including decks); location of wells /septic systems; utility locations; direction
indi -. • , . area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be ap •licable to the Iro'ect under review.
JURISDICTIONAL SPECIFICS
23 Five (5) 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 accompanied by the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, • ❑ ❑ ❑
including decks, patio. covers (over non - impervious surface) and accessory structures to existing residential dwellings .
on a lot of record approved prior to September 9, 1995.
I:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440-46t3T(11/02/COM/WEB)
TRANSMISSION VERIFICATION REPORT
TIME : 10/09/2009 08:54
NAME : TIGARD BUILDING DEPT
FAX : 5036243681
TEL .
SER.# : BROD4J479592
DATE, TIME 10/09 08:53
FAX NO. /NAME 5036844579
DURATION 00: 00:30
PAGE (S) 02
RESULT OK
MODE STANDARD
ECM
•
City of Tigard 111
13125 SW Hall Blvd. ; O
Tigard, OR 97223 I
Phone: 503- 6394171
TIGARD
FAX TRANSMITTAL
Date
Num.bcr vE pages including covet sheet 2
To: Gene Hopki xs From: Ia Ne lson dann�?a d -oxgov
Co: Co: City_�,f.Ti. and _—
Fax #: 503_684 4579 Fax #: 503 624 36 1
Ph #: 503 718 2436
SUBJECT:: Permit MST2009 -00180
MESSAGE:
Please call if I can be of help
City of Tigard
13125 SW Hall Blvd. II Tigard, OR 97223
Phone: 503- 639 -4171
TIGARD
FAX TRANSMITTAL
Date
Number of pages including cover sheet 2
To: Gene Hopkins From: Dan Nelson dann @tigard - or.gov
Co: Co: City of Tigard
Fax #: 503 684 4579 Fax #: 503 624 3681
Ph #: 503 718 2436
SUBJECT: Permit MST2009 -00180
MESSAGE:
Please call if I can be of help
l:\ Building \ Forms \Fac"1'ransmittal -P.doc 1 /18/07