Permit CITY OF TIGARD MASTER PERMIT
1 I COMMUNITY DEVELOPMENT Permit #: MST2012 -00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S102DC06200
Jurisdiction: Tigard
Site address: 13887 SW 90TH AVE
Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 11
Project: Gertz Homes at Edgewood No. 2, Lot 11
Project Description: New SF. 5/28/13, adding a /c, placement of a/c unit must comply with manufacturer's clearance
requirements. 5/30/13, reprinted to correct parcel information from 2S102DC01400 to .25 /6 ;t - DCo6'.O0
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1431 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1585 sf Garage: 421 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3016 sf Value: $330,026.96 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywall -Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temo SrvclFeeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 5 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
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 Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 3016
Owner: Contractor:
GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions)
19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 -4175
TUALATIN, OR 97062 TUALATIN, OR 97062
PHONE: 503 -692 -3390 PHONE: 503 -692 -3390
FAX: 503 -692 -5433
Total Fees: $19,574.29
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A . •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set,forth in OAR
952 9.1-0010 through O • ' 952 -01 1091. You may obtain a copy of the rules or direct questions to OUNC by caffig 503.232.1987 or 1.800.3 .2344.
Iss =d By: ` ' y Permittee Signat e: �'� � � _i:..
Call 503.639.4175 by 7:00 a.m. for the next available inspec on date.
This permit card shall be kept in a conspicuous place on the job site until compl .,: • n of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD t MASTER PERMIT
1 •
s COMMUNITY DEVELOPMENT ®. „ Permit #: MST2012 00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S102DC01400
Jurisdiction: TIGARD
Site address: 13887 SW 90TH AVE
Subdivision: EDGEWOOD Lot: 18
Project: Gertz Homes at Edgewood No. 2, Lot 11
Project Description: New SF. 5/28/13, adding a /c, placement of a/c unit must comply with manufacturer's clearance
reauiremetits.
BUILDING
Floor Areas Reauired Setbacks Reauired
Stories: 2 Bedrooms: 4 First: 1431 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height 24 Bathrooms: 3 Second: 1585 sf Garage: 421 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3016 sf Value: $330,026.96 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 5 201 -400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 3016
Owner: Contractor:
GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions)
19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 -4175
TUALATIN, OR 97062 TUALATIN, OR 97062
PHONE: 503 -692 -3390 PHONE: 503 -692 -3390
FAX: 503 -692 -5433
Total Fees: $19,574.29
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. : ' 10 : ► on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 101-0010 through OAR • 52 -' : '' • O. You may obtain a copy of the rules or direct questions to OUNC by calling 5 .232.1987 or 1.800.332.2344.
I: - ued By: _ , �� / ' � _ Permittee Signatu ': ��a. /t e .• /
Call 503.639.4175 by 7:00 a.m. for the next available inspection d • 0
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.
Mechanical Permit Application I. OIl E I S1. ()yl.1
Cl of Tigard RECEIVED Received Permit No.:
III
• 131 Hall lvd., Tigard, OR 97223 Date/By: 6 �J / -. 6) —�� 7� •
E Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
T I G A R I) Inspection Line: 503.639.4175 I ..Y 2 8 2013 Date Ready/By: Sufis: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
TYPE OF Yt4IDING DWISIoN
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.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
�� ` 1.1-- Air conditioning ( 46.75 p •
Job site address: 1 2) 8 8 7 O D - Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Suite/bldg. /apt. no.: Project name: ...0,1t4 Duct work 23.32
Cross street/diredions to job site: 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
lI Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
SCRIPTION OF WORK Gas fireplace/insert 33.39
^�
Flue vent for water heater or gas
/ `.C ,J -+ /� fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City /State /ZIP: Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: $14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State /ZIP: Minimum permit fee ($90.00)
Plan review (25% of permit fee)
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee) G
CCB lic.: TOTAL PERMIT FEE ;(5
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatu s - • Fee methodology set by Tri -County Building Industry Service Board
Print name: /— Date:
1:\Buildingwermi �. I _PermitApp_040113.doc 440- 4611T(11/02/COM/WEB)
Jan 03 13 02:26p BRIGHTEN ELECTRIC 5415497213 p.1
Electrical Permit Application f j--r t o R a b l e s ( , r: O\ 1.1
City of Ti and (l Received ��'� PertnitN
t? g Z,v Z DateBv: / 3 ,v 0/ �-S1��oZ��D /'/ /
13125 SW Hall Blvd., Tigard, OR 97223 view.
Plan Re
Phone: 503.718.2439 Fax: 503.598.19 .t f �a / e either Permit: T t :... t: D Inspection Line: 503.639.4175 0 U ' ' -' Y AT Li e Judi fa See Page 2 for
Internet: www.tigard- or.gov t te ' Supplemental Information
TYPE OF WORK JAN 0 3 201 PLAN REVIEW
Altiew construction ❑ Addition/alteration /replacement Please check all dun apply (submit i sets of plans warms checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other. CITY OF TIGAR I) where the avadabk fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION BUILDING lliv[SI il N exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
A t- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installat buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 15 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.: I Job site address: 1 3 O � S � u 9 c,Th ]oar or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: i (o a 1 0 g ❑ Heahh -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: p y 4- c S-}-, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Om. I Fee. 1 Tale I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: I 1 1,000 sq. R. or less 168.54 4
Ea add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
• DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
/ i n / Al ^ Limited energy, multi- family 75.00 2
l AV l l 1 P e. I.P �.+] l' I (a k c D► k I r � a c• r/ e residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ' ❑ TENANT 201 amps to 400 amps 133.56 2
401 tulips to 600 amps 200 34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
CI ' Temporary services or feeders installation. alteration, and /or
City/State/ZIP: relocation
Phone: ( ) 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 401 amps to 599 amps 168,54 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration. or extension, p er panel
Owner signature: Date: A. Fee for branch circuits arch
above service or feeder fee,
❑ APPLICANT ❑CONTACT PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits Ili/hour
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included) -
City/State/ZIP: Each manufactured or modular 67 84 2
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 circuitts) or limited - energy
Business name: r ` a il -f -. per- 71-r'f . L. i- c panel, alteration, or extension. Page 2 2
J Ewell additional inspection over allowable in any of the above
Address: S V 9,t' x 2;2_3( Additional inspection (I hr rain) 66.25/ hr
City /State/ZIP: S S S l 0 ci 7 7.q
Investigation (I (I mm) 78.18/ hr
66.25/ hr
I�ustrial plant (1 hr min) 78.1
one: ( 54 i) 541 -1240 Fax: (sv (') S L/q-72.-! 3 Inspections for which no fur is 90.00/ hr
specifically listed OS hr min)
/
CCB Lie.: I 3ZZ Electrical Lic.:3N — Li ?,3C Suprv. Lie.: Lj/ (075 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ✓1 Subtotal:
Y a� ~ t Plan review (25% of permit fee):
`/ i
Print name: L �. VY\ 1 V U v3j Date: ,3 / i ? State surc of permit fee):
L ! J TOTAL PERMIT FEE:
Authorized signature:
Tide 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:tnaiiding'Pccmit dELC PtrntitApp.doc 07/01110 440.4615T(1 I/OLCOM/WE6
q CITY OF TIGARD MASTER PERMIT
111 g COMMUNITY DEVELOPMENT Permit #: MST2012 -00171
Ti GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S102DC01400
Jurisdiction: TIGARD
Site address: 13887 SW 90TH AVE
Subdivision: EDGEWOOD Lot: 18
Project: Gertz Homes at Edgewood No. 2, Lot 11
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1431 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1585 sf Garage: 421 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3016 sf Value: $330,026.96 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add' 500 sf: 5 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 3016
Owner: Contractor:
GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions)
19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 - 4175
TUALATIN, OR 97062 TUALATIN, OR 97062
PHONE: 503- 692 -3390 PHONE: 503 - 692 -3390
FAX: 503- 692 -5433
Total Fees: $19,521.93
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT . regon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -00 010 through OA 52 -0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 987 or 1.800.332.2344.
Issu d By: • Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application - City of Tigard
Page I- 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. ti
Note: All new commercial buildings require 2 sets of plans.
•
•
v
r
•
I:\Building\Pennits\ MEC_PermitApp040113.doc 2 _ , _ ) '>
Buildingpermit Application
i
Residential i +it- .
VOR OFFICE USE ON1.1
City of Tigard > u !l Re«ived � —
. • I3125 SW Hall Blvd., Tigard, OR 972 3 DatdB : Z� Permit No S7 O/ "i 7
0 Phone: 503.718.2439 Fax: 503.598.1960 Plan Revi X 91 t
r l V ,� RD Inspection Line: 503.639.4175 , Date Rea��� � h✓j_ other Permijke' j� DD /
Internet: www.ti and -or. ov r r G 7 °� J / ' '— taro: ®Sx Page for
g g Noti O` 7 / 1, f � Supplemental Iaformatloa
:; ik.: .
: T M :. Oe �fia pE =
.Y.:': _�. .. •.. - • . : .- ... REQUIRED DATrti: 1� 2= R:41VBI,.*ja.Q - ,
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:
,.' :....... :, a overhead, and the profit for the
•Lr Y:7af;''a' - - - - - work indicated materials, labor, overh an e ro
s. 1 : :.4' ` {- >': _ I ' � , aia t ` n - rk ' ndicated on this a
w',.:�;i: = e..... :w�,:r��Fn':.��t'�� �-..., .- -c � ,.. :a ar,. :� � ^ 6: .:' -� - PPlication.
e t
❑ 1- and 2- family dwelling ❑ CommerciaUindustrial Valuation: $ 3-30 02.6) /
❑ Accessory building ❑ Multi-family Number of bedrooms:
❑ Master builder ❑ Other Number of bathrooms: 3
.:,•;��'... �+l�y ,�.' - t _ - ;.)r0:�ftl�4` ": - ; ?2 ; Total number of floors: -
Job site a '.::..::, . -:: _ "., ,,,�:.,, .......: .... ...' -. .. ,. ';:�:;..,.;
address: 11 S 8) S W uo New dwelling area: 16TC. square feet
City/ State/ZIP: Tigard OR 97224 Garage/carport area: 21 square feet
Suite/bldgJapt. no.: Project name: Covered porch area: square feet 1
•
Cross street/directions to job site: Deck area: square feet 1
Other structure area: 3A-37 square feet ' •
'- �A►TriiiiOni tii:.t ; a? :::, ,
Subdivision: � �� de Z I Lot no.: If i ( Permit fees * performed.
based on the value of the work erfotmed.
Tax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all
•.i.,, - ;r . s .. _ ;:;� "•., , equipment, materials, labor, overhead, and the profit for the
•.....,� ... ..- ��4- - - :�,_ work indicated on this application.
:�,+•�: .. - :•._;;:s� ; :..:... �s,::� ;�;1....... ... - _ .ls "� ' %i` =�•` pp cation.
Ai-e. `747g- Valuation: $
Existing building area: square feet
New building area:. square feet.
^•- ,t .. r rT' r,•.'1: c :1 ,ki 1i f 'M • - rte : ;; I! Number of stones:
Name: 6. -eh C-.aN �,4 4 L Type = ,.i
/G �G ! of construction:
Address: G L O f f"-T-7 Occupancy groups:
City/State/ZIP: / t„,_ ,5; 4/( ' 2 062 -
Existing:
Phone: ( 3 ) - j ' Q' 0 Fax: (, 3) 6 Z-
.;`„ .�. Q �.. .. .. 9 5' � � .3 New:
J
Business name: 6 fz c-1.-0,1e > 7 ÷. ��
Contact name: C�
147__. Structural plea review fee (or deposit):
Address: /1zap --'164.) / FLS plan review fee (If applicable):
CIty/State/ZIP: - „ Q tz_... 92 (De Total fees due upon application:
Phone: ( 5 . 6 3) 4.4r2. -3 fet Fax: : (,Sa3) G f 2,3- y3 I Amount received
E -mail: /Cam ( Osi co,Gvi i t:w
,.. ;; ,,:„ , W< i`> , Commercial and residential prescriptive tive installation of
� ; a..'tK.4 ?.,� i.:,r e �, +5: `' , � 4s' roof -top mourued Photovoltaic Solar Panel System.
Business name: G ,4I' f /' y, a Submit two (2) sets of roof plan with connection details
Addtsse: / s and fire department access, along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: �' C / „, /Z_ y 7 (96 L Permit Fee (includes plan revie
and administrative fees): $180.00
Phone: (' ) ‘c -3 I'11 Fax: (..) ) G p 2 - S Y.7 ?. State surcharge (12% of permit fee): $21.60
CCB lic.: % 3sED
Total fee due upon application: $201.60
Authorized signature: / � - Thit•patoft appilntlon e:pirp if a permit to not o b t a i n e d
/'/ within 180 daya'atter idols been seeepted.aa complete:
Print name /� D om: ' / * Feamathodol gy set by Tri- County Building Industry / ic�Sr e� Service Board
I:\ Building1Permits \BUP- RESPemntApp.doc 02/24/2011 440- 4613T(l I /02/COM/WEB)
robing Permit Application
lding Fixtures . FoR O1. •: (!sl.: (.)Ni., a-- .
• City of Tigard o Permit No,� /�_�0/ P 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: ly ®see Page z for
Internet: www•tigard or.gov Notified/Method: /6 Supplemental Information
„.....: ''_i - ,-_. -' ' . n y..,.�i.,� - Vi a!} - - - : 21: Vi a - Cli 17 vt''
� ,.._...•; ..��: �.- ...a.. r. ..,. .... . � .� . �, , '. mss- _ jsf • _ :�' -
.0
o; . truc o - ❑ Demolition For special information use checklist.
H construction X Description I Qty. I Ea. I Total
iition/alteration /replacement El Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
SFR (1) bath I 312.70
❑ Commercial/industrial SFR (2) bath 437.78
and 2- family dwelling SFR (3) bath I 500.32
cessory building ❑ Multi- family Each additional bath/kitchen 25.02
toter builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2
y . Site utilities:
p f Catch basin or area drain 18.76
:e address: / 3 8-i---2 S L Drywall, leach line, or trench drain 18.76
tate/ZIP: g ' a 454_ F7 �Z '7' Footing drain (no. linear ft.: Page 2 ,
3ldgJapt. no.: ✓ Project name: Manufactured home utilities 50.03
street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft: _J Page 2
Storm sewer (no. linear ft.: 1 Page 2 •
Water service (no: linear ft.: _) Page 2
ivision: ,,,( 5, r✓ t Lot no.: t( Fixture or item:
Backflow preventer 31.27
nap /parcel no.. _
� ,;.,, Backwater valve 12.51
,�i la; � Fz = _..; . .,- CIOIhCS WaSfIGr • 25.02
lq-e g...1 �. Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'eu i!-' rl N,,,,^.n +woq�r.,:ev , 4F / aF�PW.'4'i , :V : P -
i.« � J � i .` 12.51
Expansion tank .
.. t;co h ! ` 25.02 •
t^` Fixture/sewercap
e: G e Ch a re- G , Floor drain/floor sink/hub 25.02
:ass: / ! Z O b l'GJ q ..16 _ Garbage disposal 25.02
'State/ZIP: 1 t (,I. 2 ,& d2 92c L Hose bib 25.02
le: (S 4 3 )G42 - 33 9a Fax:(S61Pc - 5" V3 Ice maker 12.r5r1�
t'� .,.{1�t. "syY'_' ' ."f irir+a� 1 t �' z , 1 .".7:.YR7'.T.'' 1 .7"" c '"""'"-r •Rar tnterceMor/ e t� 25.02
r 't f :.N+:,. .,,A...r,ix.ai S.Ir•: -* u:.l,kotri 3, I - ..,,,'a:i'!r w -affe, ravapa.� -'.:n ik; :C+ P 2
Medical gas (value: $ ) Page
roes name: -41 eZ/E '6 4 (,e_ Primer 12.51
tact name: 44 G ...14-1_____ Roof drain (commercial) 12.51
tress: 11 Z Q a 5 cc.) 114 4.L7 Sink/basin/lavatory _ 25.02
r /State/ZIP: LL Q C Q.. ,i t 43 D „ Q ) 4:4 L Solar units (potable water) 62.54
, ne: (803) 4 92 3 go Fax: : ( 6Oj) G ? Z - ,5- / 3 3 Tub /shower/shower pan 12.51
/ e•/Lis-G. Urinal - 25.02
1811: t ., �F..vn�'ra r R Ztf�, • r .... r..n a .. Water clo 25.02
,µ r e 5 p . 1 .15 i . , ,, , , • , . (•> j Wdt. >r:�; ?'P' W` s.: W ater' h earer 37.52'
ttttesatrame: �611„„. A+ uLl•1 � i �+� Waer pipinglDVW
56.29
dress: P O 3 O p 2 7 Other. 25.02
y /State/ZIP: (,) es - 4 i i.,,n Q/Z 6, OCO Subtotal
one: ( 5 ) r 8 S Fax: (S d a )i'i 81I Z- Minimum permit fee: $72.50
SS �" Plan review (25% of permit fee)
B Lie.: I 63 7 9 Z Plumbing Lie. no.: 32 T State surcharge (12% of permit f eet) -
TOTAL PERMIT FEE
uhorized.sigaanue / This poomiltappilestaa ifsp� Mama ibY'damo
irtt llama D G'I �-- adw a hr
pearnadtafioiop sat iry Tri -Coin BmWbEladuaol' Ssvaoe Bated
I MMO 440.46I6Tttdl02bCOrdIWEB)
--- .- -w. -V.z
Fee Schedule:
Residential Fire S
°' -. -s,, ::,;�,..: ,. - �, u , . ression S stems:
- 1 (r te
Footing dra f. T 1 1 r(- A r l >1` . Y;" 9- ,� w ; ,, -
0 to 2,000 $121.90 Lr -
Footing drain - each additional 100' 37.52 2,001 to 3,600
Sewer 62.54 3,601 to 7,200 $233.20
Sewer - each additional 100' 7,201 and r
37.52
Water Service - 1st 100' 62 54
Water Srnice -each additional 100' 37.52 Medical Gas S stems:
Storm & Rain Drain - 1st 100'' ,� ;
6254 i - ,
to
Storm & Rain Drain - each additional 100' $1 to $5,000.00 "' f ` °
37.52 01 00 Minimum fee $72.50
;,. to $1 0 00
$5 0 $10,000.00 $72.50 for the first $5,400.00 and $1,52 for
• = each additional $100.00 or fraction thereof;
Inspection of existing plumbing or for and includin: $10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
minimum charge -1/2 hour) each additional $100.00 or fraction thereof, to
Inspections outside of normal business 90.00/hr and includin_ $25,000.00.
hours (minimum charge - 2 hours) $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 thereat to
Reinspection Fees 90.00/hr
Additional plan review for revisions . 90,40 $50,001.00 and u and . or the $50,000.00.
(minimum charge - 1/2 hour) P $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work:
Are you - capping, adding or replacing fixtures? If "yes",
please indicate work performed by fixture. Failure to
accurate re . ort fixtures could result in increased sewer fees *.
Ft:tu�e 1 pefoe Cinrsntlt�by F.i:tare7Acoe- e a " :; ,�. '''''''7.74.:,
Worrk1'e�ocmed: C+PPud. Added : ,..,..; . � �� -- ' �,,` , ,,
B. • tis • /Font ��• Plan review is required for any of the following.
Beth Please check all that apply.
- Tub/Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirl + . of greater, except systems designed and stamped by licensed
Car Wash -Each Stall
engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cus. idor/Weter As. irator as defined in OAR918- 780 -0040.
Dishwasher - Commercial
-Domestic ❑ Media gas and vacuum systems for health care facilities.
Drinkin: Fountain ❑ Any multipurpose fire sprinkler system.
E e Wash ❑ Any complex structure as defined in OAR918- 780 -0040.
Floor Drain/sink -2"
3" submit7 sets of plans with any of the above.
-4 "
Car Wash Drain
Garbage -Domestic-non-food r '1 ., �-; . ?v v ; ;::r.. ., �,. ti,e d m z � ....:. ;,, t : ��:,.:
•..: .. >
Disposal e - Domestic -food related Isometric or riser diagram is required for new buildings
- Commercial -food related that meet the • ualifications above.
- Industrial -food related
Ice MachjRefri: Drains
Oil S .arator Gas Station
Rec. Vehicle Dum •station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimmin: Pool Filter
washer - Clothes *Note: If the fixture work under this permit results in an
water Extractor increase of sewer EDUs, a sewer permit will be issued and
water Closet - Toilet fees- assessed for the sewer increase must be paid before the
Urinal
< Other Fixtures: plumbing permit can be issued.
http:/ /www.tigard -or. gov/ city_ halUdepartments /cd/docs/PLMF- PermitAppldoc
•
Mechanical Permit Application' ';,-- -, - ---- - 7 ---\ F012 OFFIC'E USE. ()NIA
City of Tigard !I - Received
Permit No.: s7 .-- c w/ e ) _.e 7/
1 Plan Review
I • 35 SW Hall BlvdTigard, OR 97223 /11 Phone: 503.718.2439 Fax: 503.598.1960 JUN .,,,,?; ?DI? Date/By: Other Permit:
Inspection Line: 503.639.4175
T I G A It D Date Ready/By: la See Page 2 for
Internet: www.tigard „ Notified/Method: Supplemental Information
IM.
J" .. ,, -....6 . QhVikerweitue,::. ,:... . -;.. , . : . , . - . COMMERCIAL FEEt
Mechanical permit fees* are based on the value of the work
New construction
g
0 Other:
Demolition 0 Addition/alteration/replacement
• performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
Value: $
0ittiilik4j:001:CSIOWillWi,..;::; L.:.;;;,:.'..it?'',:;.-`:,'Z'-:;;:':.
RESIDEINiTAE iirSAiiMl:3gYfi
0 1- and 2-family dwelling itI Commercial/industrial 0 Accessory building For special information use checkiLst
o Multi-family 0 Master builder 0 Other: Description Qty. Ea. I Total
74.2100.V. ,, ,: ::,::: :,i' .; •t, '.:"' Heating/cooling:
Job site address: /3 r 7 5 6 e. ) ?a (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) L 46.75
City/State/ZIP: -t - ; 7 - ,„,,,p At. f) 2ZY Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06 ..
Cross street/directions to job site: • Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75 .
Flue/vent for any of above 23.32
Subdivision: 6d . ( dro-ciP 2. Lot no.: / /
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
-..j;i':.'1 WORK i-- ,,,='..:, Water heater 1 23.32
_.:4..:,- • .'-' ,--.- :,:'. ,, _.... „ . .., . - ,-, .,. ..:-. ! .,,..,. :- ..-,... ..,_;.,.,
Gas fireplace/insert ( 33.39
S e ,t) /6, 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
-.mf..114.. , ,,••Vi; 'y,-, ,.,.& . ,:x ; ; , : ;;, - t.,...7.‘A„ . ,q , -,, .t•-i,t.:ji4, • Chimney/liner/flue/vent 23.32
- , •. ' . , ,,. . A-, .-,.- .f., , ..t.: - ., r.,- .. -70 w .' . t.4- , • - ' ', '' '"
', .-."'XIS.0:45,14...0:eir.ladiksitaa. ' !•1•••. ' ' ..!:-' 1.;,•:i J l'''., :. _. l'.:1-il'.:•.4
Other: 23.32
Name: 6, M 5 -e- e 6.-c.., Environmental exhaust and ventilation:
Address: /1 zerb 5 64 ‘1 144 Range hood/other kitchen
equipment ( 33.39
City/State/ZIP: .1.7 0 e a j Oft q )66 2.... Clothes dryer exhaust 1 33.39
Single-duct exhaust (bathrooms, 5-
Phone: 41 i -33 - 6 Fax: (3)3 )492.. -5-y 3 3 toilet compartments, utility rooms) 23.32
.. . . .
"... , .::,6 - 64 . 4i h ';',40$4600 .:-,,.:"..;;., Attic/crawlspace fans 23.32
Other: 23.32
Business name: / ex4. ed...,..e-- d 4 Fuel piping:
Contact name: i t.,... ^ ; ‘drogit'z. $14.15 for first four; $4.03 for each additional
Address: ‘72.4ro s yt -... Furnace, etc. I
Gas heat pump
City/State/ZIP: 17,....(a..4,....) DA f 7 Z..._. Wall/suspended/unit heater
Phone: (SC? ) 44 2.-- 3 .14. 6 i Fax: : 4' ) 61'2-- 6 ie?3 Water heater I.
Fireplace I
E-mail: k (4:e ,,,) e.,...ft.-C � , 4:2$0. Range /
i t's..i: LI, .., ,1`1 . ;,...!.... .,.",777,7` - ::- ::'•:,.i., .i. , „--,,,,-.;,
',!''''.,.:!;'..,,,.;., .. ;ii :: l'': ,.:;. Barbecue
Business name: &66(W C, pp cch 164edt."6 •7 Clothes dryer (gas)
Other:
Address: i 0 . .
6„, z /1681( . itmfa
City/State/ZIP: I/4 H e acaue.4. 414. i L. 8 2- Subtotal
Minimum permit fee ($90.00)
Phone: (503 ) ‘ 5- s- . 6 22.( Fax: S3) 4 SO - 211 Plan review (25% of permit fee)
CCB lie.: 4 1 /2 57 / State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permitis not obtained within 180
Authorized signature: /4„,...,„:4 days after it has been accepted as complete
Print name: e.. 440,2..-- Date: C 7 L__ ' Fee methodology set by Tri-County Building Industry Service Board
manitAino■PennitaMEC-PermitApo.doe 03/07/12 440-4617i( I 1/07JCOM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information •
Commercial & Multi-Family Fee Schedule:
utaFjjij !' Permit 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:kBuildingTertnits\MEC-PermitApp.doc 03/07/12
2
Electrical Permit Application . e, . ` FOR 01.1:1(1.: USE o'1
S i ce- .. City of Tigard Received
t • 13125 SW Hall Blvd., Tigard, OR 97223 L' �; 2 2 i' at R : ie _ , ,400 �
I D Plen Revw
Phone: 503.718.2439 Fax: 503.598.1960 Date/B ; Other Permit:
r 1 G A It D Inspection Line: 503.639 Date Ready /By: Juris: la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
apply i' ''' ',
-
z .& �".:• . : � _ - -':.� :" 4 �. ' may. -:,
a
New construction ❑ Addition/alteration/replacement P lease check all that (submit; sets of plansw/ttems checked below):
] Demolition Qther ❑ Service or feeder 400 amps or more ❑ Building over three stories.
: where the available fault current
�; ,. �" � _ ❑Marinas and boatyar
.r-;. .. .fir;:: "'.:. ; ds.
, - 64E '; : `r ' ".3 l v.; r' ; ii <; ";;•: exceeds 10,000 amps Floating _ •�i�" i ���•� am s az 150 volts or .. . .. .. . . .:...�. : �'i : :7.7;'.c.� . . _ _ ❑ g buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural '
] 1- 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
!_ ,,. ... ❑Em
., . : : - - ' 40.*: tI`t, 'I Lii'dlt poi. :„, ,., _ er S y st em .
larger Separate system
:. . ❑ Addition of new motor load of ❑ 1 A" "E" °1 2 1y „ d e rived
ob no.: Job site address: /3 $ 7 5 Gs-) r o 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
:ity /State/ZIP: l a o }h,J DA-- f 7 2 2 I ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
uite/bldg. /apt no.: Project name:. ❑ Service or feeder 600 amps or more.
:ross street/directions to job site: oerenpnon I OM I Pee I Total 1 ' '
. New residential single- or multi- family dwelling unit. •
Includes attached garage. •
ubdivision: .I , .J-'e w Z • Lot no.: I. 1,000 sq. ft. or less _ I 168.54 4
Ea. adds 500 sq. ft. or portion �j 33.92 l
ax map /parcel no.: residential I
nsFte�wr.. . Limited energy, 75.00 2
ii
:i'r •ea..®wwm+•nt z' ..§' ... ` , '!a'...,"i,�`t•..�..... (with above s q' ft.
Limited energy, multi-family '
2
., residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
N,r ry
^::.. r ' : ii'•-�;_: „�*�t .: 400 am
'�s''''r ': _ u ���s = °• .,;_�I- ..�,! . W; °'F11P.irl�'lt "'� • 201 amps to 4 amps 133.56 2 p
fame: G v4..-eZ ar 4 1 .r C...] 4--e 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2 •
.ddress: / Q ZED S G..S e {« Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation. alteration, and/or
'ity/State/ZIP: 77-4,..4..6..,..-EL, ,d 02 q 2c G Z relocation
hone: (5t6 ) fo 72.-3A To Fax: (5 3) 6104_5-1(33 200 amps or less 59.36 I
400 Winer installation: This installation is being made. on property that I own which is not tot amps co 599 amps t 54 2
ttended for sale, lease; rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 166.54 2
Branch circuits — new, alteration, or extension, per panel
iwner signature: Date: A. Fee for branch circuits with
r..
:y ,.. :,; ' f' ; y: , -.c, ,. above service or feeder fee,
,. • , ' i Fi' ...M� ; !0 ' each branch circuit 7.42 2
usiness name: G eAz`z.---Ctlr4 s-(- ea 44-e_ B. Fee for branch circuits without
service or feeder fee, first 56.18 2
ontact name: i< & mote— z__ branch circuit
/ Each addl branch circuit 7.42 2 •
'doss: / gZ�� S w 'G Miscellaneous (service or feeder not included)
ity/State/ZIP: ^, Each manufactured or modular
''t's '� A �� "� dwelling, service and/or feeder 67.84 2
hone: (5 ) 412_ z 3 dr G7 Fax: : (543) CI Z, s !33 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
-mail: EA, '�' , c.a
:`��lt� � "' . ,;. `!'�':ip yy � y �,�- r�,,,.... ., .� � •� �a „• �, tgnoroutline lighting 67.84 2
'
. t >, - ;�ii1,! in' iiii0 4;; ::........ .: • .1...:•ti4", Signal circuit(-) or limited -energy •
usiness name: A,� / a�� lc4ef�, e s f Cg panel, a l inspection PnRa2 2
Z 0 z Each additional inspection over allowable in any of the above
tidies-:
�c a. � 4 4( eN 44. 0e . Additional inspection (1 hr min) 66.25/ hr
'i.ty/State/ZIP: 5 et 6` 1 2 0 5 S ' Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr mm) 78.18/ hr
hone: (4 g` 4 Y �/
2 o Fax: (503 D� �/� �� Inspections for which no fee is
G s tficall listed %t hr min 90.00/ hr
:Ca Lic.: / $ YgZ ElectricalLic.: c...5-3-75. Suprv. Lic.lft(33S
uprv. Electrician signature, required: Subtotal:
Plan review (25% of permit foe):
/ 4
tint name: Apt/ Date: Stat surcharge-(12% 12% of
• _"VVJ � p x � u Z arge ( permit fee):
TOTAL PERMIT FEE:
,uthorized signature: This permit appends. espireolf a parent Is net obt.i..kwithis tes•
tint name
Daze: - L dap atlas if ba.bessaeespesin eo.psss.
• Number of inspections allowed per permit.
HLC- PanosApp.doo 07/01/10 440.4615T(11ros1COMf*
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
C Burglar Alarm
123 Door Opener*
Heating, Ventilation and Air Conditioning System* •
21 Systems*
❑ Other:
•
. ik. �, 1 1'^�ti'.�S�F7_ °i:�J:;`;:`:i
Fee for ear 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 •
❑ H VAC . •
❑ Instrumentation
❑ Intercom and Paging Systems
❑ L andscape Irrigation Control*
❑ M edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
c\awiei v mZ-aeemApp.eoo 07/01/10
° Building Division
Development Code Provision Review
T 1 C A R D Residential Projects
Building Permit No: /S 1: 2 O/o 2 - — eV/ V
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans:
Original Plan Submittal Date: 4/740
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact Gliteiti Ca; nes at 503 - 718 - 07 or cite o c- @tigard - or.gov)
Land Use Case No. StA.13 a 00013 Name (� eIkr +iO"ne' 0.-- G.e /C oc) c- a
Zoning R -14 • S
j§ Setbacks:
Front Q0 Rear ( 5 Side 5 Street Side 15 Garage a o
Maximum Building Height .3 O P+ Actual Building Height a 'c4
Visual Clearance
pi Easements 7.5-� SVlOw1.1 , e c.c.s 11 + gro M °s r 2 —
r( Sensitive Lands Type: NI A
Notes: - - - V - - — : -
- - V ■-- - 0 k - CO %,-e -�
p oY c-1 n t s a -PC- ....... - w; I d , ..1 4- ,,) It,.:.. .d-vt se_f cK • e ___
Original Plan: Approved, . Not Approved Date: 4 - aet - la
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)
,0" Actual Slope:
Notes:
Original Plan: Approved ePf Not Approved ❑ Date: 1
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City tjrborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov)
• L7 treet Trees
Protected Trees
Notes:
Original Plan: Approved LrY Not Approved ❑ Date: 1'2 ?
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 Ap • ant
Okay to Issue Permit: Yes N ❑
Date Routed to Building: ?// )
•
Page 2 of 2
September 12, 2012
RE: NEW RESIDENTIAL
Project Information
Building Permit: MST2012 -00171 Class of Work: New
Address: 13887 SW 90 Lot Number: 11
Area: 3016 Sq. Ft. Stories: 2
Builders Name: Gertz Homes Subdivision: Edgewood 2
The plan review was performed under the State of Oregon Residential Specialty Code
(ORSC) 2011 edition. Please respond to conditions below.
1) Please show complete compliance with ORSC R301.2.2.2.5 item #lfor front,
first and second floor braced wall lines.
When responding, provide an itemized letter stating in what way each numbered
issue has been addressed in the revision.
When submitting revised drawings or additional information, please attach a copy of the
City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard
in tracking and processing the documents.
Respectfully,
Dan Nelson
Senior Plans Examiner
(503) 718 -2436
dann @tigard - or.gov
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C ONSTRUCTION
T CO MPANY INC.
G ER ,
HOME SQUARE FOOTAGE BUILDING _,
/ \ MAIN FLOOR = 1431 SQ.FT.
�N► -
UPPER FLOOR =1585 SQ. FT. CUSTOM HOMES SINCE 1977 Amerananas2" lia
(503) 692-3390 Street
TOTAL = 3016 SQ. FT. 13887 SW 90th
GARAGE = 421 SQ.FT. Lot 11 EDGEWOOD EAST
SCALE 1' = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13887 SW 90TH AVE, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
05/23/2013 00:00
MST2012-00171
FAIL
Add AC to permit OSSC R105.1
Provide adequate signage at dryer duct outlet, For overall length of duct installed ORSC
M1502.4.5
Provide documentation for under floor duct air leakage test OSSC AF103.4.8
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13887 SW 90TH AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
05/28/2013 00:00
MST2012-00171
PASS - C of O
Final Inspection requires:
Erosion approval
Moisture Content Acknowledgement Form
High-Efficiency Interior Lighting System Form
Street Tree Compliance Form
Blower door test Received for radon requirements
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13887 SW 90TH AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
05/28/2013 00:00
MST2012-00171
Scheduled
Final Inspection requires:
Erosion approval
Moisture Content Acknowledgement Form
High-Efficiency Interior Lighting System Form
Street Tree Compliance Form
Blower door test Received for radon requirements
Violation Summary:
Inspector Contractor
STREET TREE
TI;GARD CERTIFICATION
, agent owner/a g f or cif-2-z- /1--e14--e-J
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certify that the following location meets
City of Tigard land use and development standards
for street tree installation and is consistent
with the approved site plan.
PERMIT NO.: m S-'- 2- '/Z -- ea-4/7-/
511E ADDRESS: /3 7 7/9- • //J/Die
SUBDIVISION: LOT#. //
SIGNATURE: `! DA 1 E: 512J--h,
(OWNER/AGENT)
RECEIVED &
VERIFIED BY DA 1 E:
çOF TIGARD)
❑ Tree location verified per approved site plan.
I:\Building\Forms\StreetTreeCeraficate 05/30/2012
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
, am the general contractor or the owner-builder
at the following address:
Site Address: ,3
/ if/4J
g Qe 7r/t'
City: r, 'Z
Permit#: Z O/Z — OOl7/
Subdivision/Lot#: %-7/4J
and/or
Map and Tax Lot#:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture-sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: Atk Date: `S/5//2
G neral Contractor or Owner-Builder
I:\BuildineForm\RES-MoisturesensitiveWood.doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: r- 7 /Z -U 17( Jurisdiction:
////901
Site Address: 13 g,7 (5-4.) A'd7
Subdivision/Lot#: j //
and/or
Map and Tax Lot#:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)1
Signature: Date: -1247/3
Owner/General Contractor/Authorized Agent
Print Name: e j'a-✓ /2tA l..
ORSC Section NI 107.2.High-efficiency interior lighting systems. A minimum of fifty(50)percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent,or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw-in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent,or a minimum efficacy of 40 lumens per
input watt.
I:\Building\Forms\RES-HighEfficiencyLighting.doc 07/01/08