Permit n CITY OF TIGARD MASTER PERMIT
111 IS ' COMMUNITY DEVELOPMENT Permit #: MST2012 00286
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 12/11 /2012
Parcel: 1 S134DC08500
Jurisdiction: Tigard
Site address: 11549 SW TWIN PARK PL
Subdivision: TIGARD PARK Lot: 1
Project: Conner
Project Description: 348 sq ft addition for bedroom, bathroom and laundry
BUILDING
Floor Areas Required Setbacks Required
Stories 1 Bedrooms: 0 First 348 sf Basement 0 sf Left 5 Parking Spaces' 0
Height. 0 Bathrooms 0 Second 0 sf Garage 0 sf Front 20 Smoke
Dwelling Units. 1 Third 0 sf Right 5
Detectors Yes
Total 348 sf Value: $31,500.00 Rear 15
PLUMBING
Sinks. 0 Water Closets: 1 Washing Mach 1 Laundry Trays 0 Rain Drain: 0 Unnals 0
Lavatories 1 Dishwashers 0 Floor Drains* 0 Sewer Lines 0 SF Rain Storm Sewer 0
Tubs /Showers 1 Garbage Disp. 0 Water Heaters 0 Water Lines. 0 Drains 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain 0 Ice Maker 0 Hose Bib 0 Backwater Value 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning N Vent Fans 1 Clothes Dryers 1
Heat Pump N Hoods 0 Other Units 0
Fum <100K 0 Vents 0 Woodstoves 0 Gas Outlets 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less 0 0 -200 amp 0 0 -200 amp 0 W/ Svc or Fdr: 0
Ea add', 500 sf 0 201 -400 amp 0 201 -400 amp 0 W/O Svc/Fdr 5
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 Descnption. Ecompasing N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R -3 348
Owner: Contractor:
CONNOR, SEAN P 8 DANA K Required Items and Reports (Conditions)
11549 SW TWIN PARK PL
TIGARD, OR 97223
PHONE. 503- 277 -8670 PHONE
FAX:
Total Fees: $1,710.27
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 ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through 0 R/ 5 2- 001 ;090 You may obtain a copy of the rules or direct questions to OUNC by calla • 50 800.332 2344
Issued By: �✓L _- Permittee Signature: - ��
Call 503.639.4175 by 7:00 a.m. for the next available inspection ,./*
This permit card shall be kept in a conspicuous place on the Job site until compl: -
Approved plans are required on the job site at the time of each Inspection.
#-Eluiiiiirie Permit Application RECEIVED
Residential FOR OFFICE USE ON I 1
City of Tigard NOV 21 2012 Received //.44115 7: fS7,2p /o2 - 042,4
Permit No It
13125 SW Hall 'Cigard,OR 97223 Date /B v: 9�� iew ►.�� Other Permit:
. Phone: 503.718.2439 .2439 Fax: 503.598.19 � TIGARD DateB
vARD Inspection Line: 503.639 BUILDING D Date ReadyBy: r I ' �f :furls. fa
See Page 2 for
Internet: www.tigard- or.gov Notified/Metho (t f (��` 77. Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A Addition/alteraion/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
A l- and 2- family dwelling ❑ Commercial/industrial Valuation: $ � .52
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: Z
Job site address: 11 5-4 9 A ] Jr.) p I New dwelling area: 3 square feet
�• D
City /State /ZIP: v �+� T q Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
—7-, ref Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees' are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
„ d, / a K L� m / I / _ th / a . Valuation: $
( .... „1+ ; // „ U ,. ` Z' �... ` Existing building area square feet
New building area: square feet
PROPERTIj OWNER I ❑ TENANT Number of stories:
Name: ?" t/
n 0n�L, Type of construction:
Address: / / ) ' q l 7/�/ J pmk y Occupancy groups:
City /State /ZIP: T ri A 4" ( ? 1 L -Z� Existin g:
Phone:
( )27/"70 Fax: (60) �Z`Q - 5) /V New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: 0 /4 it 1 V (NbT (Please rya Avla sellable)
Structural plan review fee (or deposit):
Contact name: Pa-h CeiniV ie. 3 (Z� FLS plan review fee (if applicable):
Address: CM t✓ (p(2-
Total fees due upon application:
City/State /ZIP: CK OP ys.
� 1 Amount received:
Phone: (<327) �5 77 W/ 70 I Fax: : ) �0 ziQ ,5 i o
E -mail: �/ j_ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
An /7ll Cu t i it `/J( T Commercial and residential prescriptive installation of
CO roof -top mounted PhotoVoltaic Solar Panel System.
Business name. / Submit two (2) sets of roof plan with connection details
=` ' r ! A - �4 ' �� and fire department access, along with the 2010 Oregon
Address: n GI / r] �J�/J��J Solar Installation Specially Code checklist.
Ci ty /State /ZIP: 7):474A I / 5P...... /123 u^ Permit Fee (includes plan review $ 18000
Gl (i and administrative fees):
Phone: 96) 77 g 70 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
(7:..------) within 180 days after it has been accepted as complete.
Print name r' r ✓J ( � ,yy Date: 4 1 _ 6 / * Fee methodology set by Tri County Building Industry
r t Service Board
1: 1Building\Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 46l3T(11 /02/COM/WEB)
BuildinE Permit Application Checklist
One- and Two- Family Dwelling FOR OFFICE USE ONLY
City of Tigard D «` Permit No
1 11 4 i 13125 SW Hall Blvd. Tigard, OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24- Hour Inspection Line: 5013.639.4175 0 Electrical 0 Plumbing 0 Mechanical
I I GA R D
Internet: www.tigard- or.gov ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Y'es No NIA
1 Land use actions completed. See jurisdiction criteria for concurrent revioks. ❑ ❑ ❑
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 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area building coverage area percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
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. ❑ T ❑ ❑ _
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore • on and shall be shown to be a • • licable to the •ro'ect under review.
.Ii I RISDICTIONAL SPECIFICS
e Three (3) si .• plans are required for Item 11 above. Site plans must be 8 -12" 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. ❑ G ❑
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 must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\BuildinglPerrni ts\BUP- RESPermitApp.doc 02/24/2011 440- 613T(II /02/COM/WEB)
Plult�nbin2 Permit Application RECEIVE
/�R. It >lt ( >1 , I( I«l: ONI.l
MI City of Tigard NOV 2 j 2 012 R`ceived Permit No.
•
13125 SW Hall Blvd., Tigard,OR 97223 DateBy. ` �T �O� �p
Phone: 503.718.2439 Fax: 503.598. I Plan Revtew Other Permit No.:
Inspection Line: 503.639.4175 TIG l � D , ateBy:
TIGARD Internet: www.ti ard or. ov BUILDINGDIVISI I N ate Ready/By: Luria: ®See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
F rNew construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
.tddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
IR(l- 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: � Catch basin or area drain 18.76
� ; l " 7 y / ��� pl Drywell, leach line, or trench drain 18.76
City /State /ZIP: / /� //� Q plitt_._
/ �� (//� Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: % i !� /7v s , ir Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer l 25.02
//i .i 7, / • =I if AI Al 1.• "/ /I' ./,, Dishwasher 25.02
/
_ I ' I :.%�/� /. e .L• L ' L / Alt' „ / Drinking fountain 25.02
G J ' / Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 2 ��) -��� Fixture /sewer cap (�v 25.02
w� Floor drain/floor sink/hub 25.02
Address: ' /cam �/v 77/14,-2'' i ht(i
/A / n (( g e 2-z Garbage disposal 25.02
City /State /ZI 0 C Hose bib 25.02
Phone: (67-o) `/277 - Fax: (92 f/ - 6V90 Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
D 1n 7 /� Medical gas (value: $ ) Page 2
Business name: v CT
Primer 12.51
Contact name: /�'� t»
`'(� 6J! t Roof drain (commercial) 12.51
Address: 7/ '1 /ti 1644/1 z7,7. /, . G2 Sink/basin/lavatory ( 25.02
City /State/ZIP: / / A. r� d / ! 7 2 2 /1 5 Solar units (potable water) 62.54
Phone: i; 0 / _ ar , 1 0 _ Fax: / %_ 1 /O Tub /shower /shower pan (. 12.51
Urinal 25.02
E -mail: Dana Al,(_•t./'1 �? dr 67m�a, , /7,7 L e
CONTRACTOR Water closet I 25.02
/ Water heater 37.52
l
Business name: 5e _ / ��(X/ / Water piping/DW V 56.29
Address: f / 7 � } -- /yam E/ �/1l�� Other: 25.02
City/State/ZIP:-1 / ` ' ' f 3 - � Subtotal
Phone: ( gf ^ Fax: (/t`,) / `yD Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/, State surcharge (1 fee)
Authorized signature: / z TOTAL PERMIT FEE
Print name: ` G Date: This permit application expires if a permit is not obtained within 180 days
e . J '� o r 1 ��/ // after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616r(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 - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37 52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 " that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I: \Building\Permits\PLM- PermitApp.doc 2
Mechanical Permit A licatio FOR OFFICE USE ONLY
City of Tigard EIVED Received
III City Date/By: Permit No/�57� .. _ � AF6
1 3125 SW Hall Blvd., Tigard, OR 97 223 Plan Review CJ
1 111 Phone: 503.718.2439 Fax: 503.598.1960 Mn
—V 21 2 012 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Read orris: ®See Page 2 for
TIGARD Ready/By:
www.tigard or.gov CITYOFTIGARD Notified/Method: Supplemental Information
__ BUILDING-DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
[New construction ddit ion / alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, aid profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist.
❑ ulti- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
�/ Air conditioning
Job site address: /`!� L�q )7 p/dc-e- (requires site plan showing placement) 46.75
City /State /ZIP: `�� !!! / //}� � � J3 Furnace 100,000 BTU ( ducts/vents) 46.75
/ !i / c- ` 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
/ �/�� t Residential boiler (radiator or
hydronic) 23.32
/// Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75 ,
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
/ Gas fireplace/insert 33.39
A . 4/ M r1 A. i / / / ._ice /' /, ■ %/ Flue vent for water heater or gas
firigir �.� / fireplace 23.32
�/ / , L /� /// /.14. Log lighter (gas) 23.32
/
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
4PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: _ 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust ' 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax:
( ) toilet compartments, utility rooms) ( 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: y ,/ g /1-ek L Clothes dryer (gas)
Other:
Address: / a9 ya Sr $ /V'vySfi -,Pa f /fa yf,.. MECHANICAL PERMIT FEES*
City /State /ZIP: G'G S � ex Z /5' Subtotal
Minimum permit fee ($90.00)
Phone: (..5-6,9) 71,/ — g90 n Fax: ( ) Plan review (25% of permit fee)
CCB lic.: f 7a yy /7//r 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: S Date: I I 1 ai l �a * Fee methodology set by Tri- County Building Industry Service Board
l am _13" .co r
I:\ Building 'Permits\MEC- PermitApp.doe 03 /07/12 440 -4617T (I 1 /02/COM/WEB)
• 0.
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.
1: \Building\Permits\MEC- PermitApp doc 03/07/12 2
�
City of Tigard d
gi
� Pau °r "ST /� -. (�(jsZ� ( G
13125 SW Hall lvd.. Tigard OR 97223 Z L��Z
P1an Review
Phone: 503 718.2439 Fax: 503.598.1' . lhaelBr Other Permit .
Inspection Line: 503.639.4175 OI~TIGARD Date
ied/M fa see Pitt Sfor ra
Internet a�rw,t �gard ot.gav BU� { It �'� ;v `onti
Notified/Method. Supplemental leforatioa
TYPE OF WORK 1 r ld Ium _ I PLAN REVIEW
Q NCw construction tlditiotvalt�•ration/r i 1- — y tai I Please check all that apply (submit sets of plans w!ecau checked below):
t ❑ Service a feeder 400 amps or more ❑ Building ocer three attain.
❑ Demolition ❑ Other. 0 3 2012 where the available fault canent ❑ Marinas and boatyards
CATEGORY OF CONSTRI M exEeeds 10.000 amps a ISO volts or ❑ Floating buildings.
xv less to ground. a t
d. or cceds 14.000 ❑ Commercial-use a,� ur
cultal
12' '4.4. • � f t = , Kling - and 2 fitmily dwelling 0 Commercial/indn I t i 17 - Kling reps for a villa installations. buildings 4. ❑ Multi family ❑ Master builder 1 61 i : I iON ❑ frrc PIIMP. ❑ Installation of 75 KVA or
❑ Ernergarcy system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ `.t „[ ' „1 - •.1 _r oc
Job no.: lob e add
sit ress: I /�J h /A l ooHp m mree.�wne]
to add /- �� L --Jt -- /a./f/ / /hest ❑ Jtr ur mum residential units. ❑ Recreahunal vehicle palks.
City/State/ZIP: 1 _ �.� 72 7 / ❑ Healthcarr e facilities.
❑ Hazardous a❑ Supply voltage for more than
600 volts nominal
locations
Suite/bldg./apt. no Project name- ❑ Service or feeder 600 amps or more.
street/directions . site: ,,
Cross street/directions FEE SCHEDULE _
Job / Desc riAt+a Qnt- F ie_ Taal 1
-- New residential single- or multi-family dwelling unit
includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
1
Tax map/parcel no.: Limited ne0 enemy. 33.92 1
residential
75.00 2
DESCRIPTION OF WORK (with above sq ft )
/ l KcT )� (/ / /' Limited energy. multi - family 75.00 2
& (7 l in / /I bj i1: ) L /" 1 ere(. f, 7 7 . L2S, residatml (with above sq. it)
i t i [ /lit �,/ r/ ., Services or feeders irtatallatioa, alteration, and/or relocation
' - 5L - 1 i / it ti u lii 1 (g 200 amps or less 100.70 2
❑ PROPERTY 011aiER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to LOGO amps 301.04 2
Address: Over 1.000 amps or volts 1 552.26 2
City /Stat+lLlP: Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) 1 Fax- ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is rot 2
intended for sale. lease, rent. or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 160.54
Branch circuits -mew, alteration, or extrados. per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT i X CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name. er i /i /A1 - s r /�. B. Fee for brrnh circuits wither
/'l r ` � service or feeder fee, first t 56.18 6 - $ 0 2
Contact name. i a,A142 . , p d v .....s- branch circuit �. 2
Each add'I branch circuit 7.42
Address: SP7 1 Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.8.1 2
S /j an
dwelling, service and/or feeder
Phone: ( ) --- Fax; : ( ) Reconnect only 67.84 2
E-mail: �jT/f, G) <AAIL•/iJeSr • cp�j pump or irrigation circle 67.84 2
CON Sign outline lighting 67.81 2
L , /vl r Signal circuit(s) or limited- energy
Business name: 5 094) ' s T G o . panel. alteration or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: iO. ‘ D !yc? 7 ' Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 7
9 .5 O� Inv Simon (t hr min) 6625/ hr
` Industrial plant (1 In min) 78.18/ hr
Phone: d33 ► l -g? -3y3 I Fax: (s) 4 -37x3 Inspections for which no fee is
specifically listed t%: hr min) 90.001 hr
CCB Lie.: �3 / Electrical Lic.: 'y - a L 4 5 7 6 - 41P- Suprv. Lie.:
....... ELECTRICAL PEILRIf FEES
Suptv. Elcctricit aignatut required: 1APi�i � Suitt ): R
. Plan review (2�°fa of permit fee
'-- ----»
Print name: ZeN440 [/ / ? S4�/� Dat : // / State surcharge (12%ofprnnit fit) �a
Authorized signature: /,J` i TOTAL PERMIT FEE: � g�- /!'/+'4- T6i permit application ires it a permit is tot obtained within 180
Print name: Date: i days after it 1w ban accepted as complete.
I • Number of inspections allowed per permit f
i `Buddiq Pernits'ELC- Pamit#pp doer 07!01:10 440 -i6 t STi 1 t ;ostOWWEB
I s " Building Division
Development Code Provision Review
TIGARD
Residential Projects
Building Permit No.: / /oZ — Ma-Pa
Site Address: //S ? .) 774 'N Affret. /
Project Name & Lot No.:
CWS Service Provider Letter
Required: Yes ❑ No
Received: Yes ❑ No ❑
Routed Plans:
Original Plan Submittal Date: //A/A2
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 appro &cl.
Planning Review (contact ' ' - _ J: at 503 -718 - 3 or 9p @tigard - or.gov)
Land Use Case No. N /
Zoning J ^ 'Ii r
0 Setbacks:
Front 20 Rear C< Side S Street Side / 6 Garage &O
-i Maximum Building Height: 3 C Actual Building Height 4 3 v
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
❑ Street Trees
❑ Protected Trees
Notes: �a� 6 , / Mb t 9 ! �/a Aie, ,Y, _ /i1 4 e
IC 1
Original Plan: Approved An Not Approved ❑ Date:
// —z/ — J Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
RI' Actual Slope: / m
Notes:
Original Plan: Approved � Not Approved ❑ Date: ('Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes No ❑
Date Routed to Building: /( /,6 1 )�
Page 2 of 2
RECEIVED
Property Owner Statement Nov 21 2012
Regarding Construction Responsibilities crryoFTIGARD
Oregon Law requires residential construction permit applicants who are not license JifI$pWGDIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Na a of Permit App t
(l �' // ,
ign ure of P Applicant Date
Permit #: /`1S7 0 /a —DOvtaFG, •
�/� -'A) T7�J /n/ 4174e
Address: �s �,�-
♦ i:': Y- . _. �, S.1 a �
�
. �t. ;.
Issued by: �-� Date: r f I (! / �
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11549 SW TWIN PARK PL, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
06/20/2013 00:00
MST2012-00286
PASS - No C of O
Violation Summary:
Inspector Contractor