Permit Building Permit Application EXPIRED 014.z 4Y1 -----
Residential �
` FOR OFFICE USE OiNi,V •
Ill City of Tigard
Blvd., E I Recei . (��J I . Permit No.: , _
° 1312 SW Hall Bld., Ti ard, OR 97223 T �E '1 •••/ ,
Tigard, 41\ Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 �j� Date/By:
TI G n R D Inspection Line: 503.639 Z Q D ate Ready /By: Juris: ® Sec Page 2 for
Internet: www.tigard or.gov SUN p �� ,, ��Notifie d/M ethod: Supplemental Information
TYPE OF WORK MIX
("W' p N REQUIRED DATA: I -AND 2- FAMILY DWELLING
El New construction El Dem>i �,I71N Permit fees* are based on the value of the work per formed.
Indicate the value (rounded to the nearest dollar) of all
® Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the prof it for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling El Commercial /industrial
Valuation: $9800
El Accessory building El Multi-family Number of bedrooms: 0
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: 10140 SW Walnut St. New dwelling arca: 121 square feet
City /State/ZIP: Tigard OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: ath �r ®j')C.
Pro Covered porch area: square feet
Cross street/directions to job site: From 99W go on W Walnut and after you Deck arca: square feet
pass Grant Ave. the third house on left Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work per formed.
Tax tnaplparccl no.: 2S102BC01100 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the prof it for the
DESCRIPTION OF WORK work indicated on this application.
I want to add three outside bathrooms and remodeling bath inside Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Anamaria & Cristian Gonczi Type of construction:
Address: 10140 SW Walnut St. Occupancy groups:
City/State/ZIP: Tigard OR 97223 Existing:
Phone: (503)7465737 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Raul Onescu All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors B oard
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If t he
City/State/ZIP: applicant is exempt from licensing, the following r casons
apply:
Phone: (971)3229416 Fax::( )
E -mail: raulone28 @yahoo.com
CONTRACTOR
Business name: by owner BUILDING PERMIT FEES*
Address:
(Please refer la fee schedule)
Structural plan review fee (or deposit):
City /State/ZIP:
FLS plan review fee (if applicable): i.
Phone: ( ) I Fax: ( )
u
CCB lie.:
Total fees due upon application: 1 4 , 7-7
_ / Amount received: 19 -', 7
Authorized signature:
T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: e ,/, Q 4 604 e alf I Date: 6/01/2010 • Fee methodology set by Tri- County Building Indus try
Mechanical Permit Application - - - FOR USE ONLY
City of Tigard Received
Date/By: 13125 SW Hall Blvd., Tigard, OR 972� Plan Review i 3 " Permit No.: /}�� AL U� 94
III C Phone: 503.639.4171 Fax: 503.598 . I i LJ DateBy: Other Permit:
I' I G A Il 17 Inspection Line: 503.639.4175 n +o Date Ready/By: ® See Page 2 for
�� Internet: www.tigard- or.gov O2 717 NotiNotified/Method: r Supplemental Information
TYPE OF W Y OF D S N. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/altegtaitaement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
/ jig 1 -and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ 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
Job site address: fix/ Si. ir conditioning
eO(/ �O N / / �/�/ t/ (requires site plan showing placement) 46.75
City/State /ZIP: ) ®/l q> 2P 3 Furnace 100,000 BTU (ducts/vents) 46.75
f d I / Fumace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: p p re-01 ' Heat pump 61.06
Cross street/directions to job site: l / 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
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
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
[il PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: AN " Arc e cri,„ �I' q A Korte2(t Environmental exhaust and ventilation
//�" Q v ''
Address: Q '' ` SW y W / Q //1404 .6917% Range hood/other kitchen
" equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 50 3) X4(o — l 3 - Fax: ( ) toilet compartments, utility rooms) 3 23.32 C1-
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: kQ l at ere..., Other:
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: ( 9 3 2? 74/e Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: ` 4c &Me f Clothes dryer (gas)
(]� Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) qV . O''')
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits'MEC- PermitApp.doe 10/01/09 440- 4617T(II /02/COM/WEB)
1
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.
I:\Building\Permits\MEC- PermitApp.doc 10/01/09 2
Plumbing Permit Application
Building Fixtures ��� 1:012 (►rricl: usi: ONLY
City of Tigard ��]C� � Received A 5 ' 7 -�
111111 a 13125 SW Hall Blvd., Tigard, OR 9723 O �j � 0 D v . la/ � Permit No.: / 10 - l3r?CJ ffa
G Review /r /
Phone: 503.639.4171 Fax: 503.598.1960 \� \` Other Permit No.:
t� ♦ Dat e/B Plan y:
T I G A R D Inspection Line: 503.639.4175 G C,O Date Ready /By: Dais: ® See Page 2 for
Internet: www. tigard- or.gov � .,c,( O .� ii ` c ),N1' Notified/Method: y7 O Supplemental Information
TYPE OF WORK C �� p l� FEE* SCHEDULE
❑ New construction ❑ Dt�(itolition For special information use checklist
Description 1 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 builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10140 SW Walnut St. Catch basin or area drain 18.76
City/State /ZIP: Tigard OR 97223 Drywall, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Proposed bethrooms Manufactured home utilities 50.03
Cross strect/directions to job site: From 99Wgo on W Walnut and after pass Manholes 18.76
the Grant Ave. , the third house on left 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: 2S102BC011100 I Lot no.: Fixture or item:
Tax map /parcel no.: Backlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 1 2.51
Clothes washer 25.02
I want to add outside bathrooms and remodeling bath inside Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Anamaria & Cristian Gonczi Fixture/sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 10140 SW Walnut St '
Garbage disposal 25.02
City /State/ZIP: Tigard OR 97223 Hose bib 25.02
Phone: (503)746.5737 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Raul Onescu Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: . Sink/basin/lavatory 3 25.02 75-. Cib
City /State/ZIP: Solar units (potable water) 62.54
Phone: (971) 3229416 I Fax: : ( ) Tub /shower /shower pan 12.51 -
E -mail: raulone28@yahoo.com Urinal 25.02
CONTRACTOR Water closet 3 25.02 75 .
n
Water heater 37.52
Business name: by owner Water piping/DW V 56.29
Address: Other. 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: C't�- TOTAL PERMIT FEE
Print name: Cristian Gonczi Date: 6/2 /2010 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.
EXPIRED'
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�l TIGARD -SITE PLAN RIVI W '.
BUILDING NO
Seed Tram
ggprove d 1� a A'
1' Ili Date : C 13 / ?Diti proved ,
Cam...' CITY OF MAN) - SJTE PLA!4 REVIEW
• BV#j 4 DING PERMIT NO.: fS3Pcik) 'cXd?(
PLANNING DIVISION:
L� LC(' / Required Approved ❑ Not Approved U i -F D
O A : Side: 5 Street Side: /
Front. Gage: Rear: a___ l ?
Visual Clearance : roved fl Not Approved
Maximum Building Height %v tees i
CWS Service Provider Letter Required: [Q Yes ❑ No
J � 0 Recei-ved
B� : 0!/Ul��-1 Date: {9/2'�l D .
ENGINEER DEPARTMENT: . ,
Actual SI pe: % Approved ❑ Not Approved
Site Plat . ❑- Approved ❑ No Approved
. G�/ �— Date: 1 9 I 0
Notes: c d ( 2ti s ,-/
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