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Permit . ° Community Development TIGARD Request for Permit Action - � OCT 3 2007 CITVQF riG TO: CITY OF TIGARD 1111ILDINGDIVIgy®hi Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: igi Owner ❑ Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) , :,.. Mailing Address: v u I 1 • City /State /Zip: /6/0 7 er Vifr" Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). 1 �ti r i Permit #: I67'' (x, i zE / o Site Address or Parcel #: [ AV) 1-L..4,14.r ' j Project Name: R. L-t-enl.f L Subdivision Name: Lot #: EXPLANATION: t i -p s /JO r - re, S¢-e r »T -1 74 - 1.5 -1--1 F . Signature: X�� i Date: /eygh 7 Print Name: // 4, �' Refund Policy •/ 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits . d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S s Admin: Date At , . Rte to Bld • Admin: Date /O� 'O 7 B i Refund Processed: Date A/ 4 By Invoice Processed: Date By Permit Canceled: Date jq /1 7 � By '' Parcel Tag Added: Date By Receipt # Date Method Amount $ 1: \ Building \ Forms \RegPermitAction doe Rev 07/26/07 CITY OF TIGARD FEE AND PAYMENT HISTORY q 1111 C . _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD MST2007 -00140 - 12810 SW WALNUT ST Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due [CDCPLN] CDC Pln Rev 100 -0000- 433060 $46.00 $46.00 $46.00 [LRPF] LR Planning Surcharge 100 -0000- 438050 $6.00 $6.00 $6.00 [BUPPLN] Pin Rv Balance 245 -0000- 433000 $118.06 $118.06 $118.06 Totals for Fees $170.06 $170.06 $0.00 $170.06 Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount Total Pay $9.0 Balance Due: $170.06 -------7) Building Permit Application D 0 U 0 D/9 0 4?- Residential _� �1(`. P7�� FOR OFFICE USE ONLY l— . 7. _._. . ] City of Tigard Received • �G7 ,, Permit No• _ 5 fir• , { RIO ° 13125 SW Hall Blvd., Tigard, OR 9743) G 0 2007 ��II ' Plan Review : C Phone: 503.639 4171 Fax 503 598 1960 DateBy: Other Permit Inspection Line 503.639.4175 CM d 7 i .:.); :- ^ 1' �+I® Date Ready /By tu. El See Page 2 for TIGAKD Internet: www.tigard - or.gov S�tle Y� O DiV13 ON Notified/Method. ' 1 (.. 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 ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El I- and 2- family dwelling ❑ Commercial /industrial Valuation: $ aS ❑ Accessory building ❑ Multi- family Number of bedrooms: t� �Xlyf� 0 Master builder ❑ Other: Number of bathrooms: if E el rCP JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 12.8 I. Sti /4 2 m i via i i^ _r-i New dwelling area: 130 square feet City /State /ZIP: 119eLe'S 0 R 97223 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: Pane Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 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. /� Q s k 4. f e() Valuation: $ �f �i / `OCS�' f Existing building area: square feet New building area: square feet 124ROPERTY OWNER I ❑ TENANT Number of stories: Name: 71 al.9.as ,44. u , f } Type of construction: Address: i 2.810 sv la, 1 h ,i. S9 Occupancy groups: City /State /ZIP: r i ci.r 0 & 9 7e. Z3 Existing: Phone: (S A') 22;0_ ?Lag Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact 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:( ) I Fax::( ) E -mail: CONTRACTOR ` Business name: C 4s +r/" r_ ria l U) l tt BUILDING PERMIT FEES* Address: f r a.<. ; c. r,/ (Please refer to fee schedu J City /State /ZIP: -77,,, „ e) / 4" ?ZZ;1 yip, .'I g O ��� Structural plan review fee (or deposit): ( Q J ` - Fa x: ( ) FLS plan review fee (if applicable): Phone: ` . ) Say - - 7 S s2`� - 869 7 CCB lie.: 1S24 - Total fees due upon application: Amount received: ... Authorized signature: This permit application expires if a permit is not obtained • G �°�!"'�'� within 180 days after it has been accepted as complete. Print name: ? �� yH � _� Date: / ?J�l * Fee methodology set by Tri- County Building Industry ` ' / ti 7 Service Board. ,, 1.\Building \Permits \BUP -RES PermitApp.doc 02/23/07 440- 4613T(I I /02 /COM/WEB) /70 I d 44171 /�6 /674) eeireCE7 ,1 ) !i Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY • City of Tigard Received permit No IN Date/By q 1 3125 SW Hall Blvd ,Tigard, OR 97223 Associated permits C Phone 503.639.4171 Fax 503.598 1960 T I G A IZ D 24- Hour Inspection Line 503 639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet. www.tigard- or.gov ❑ Other. THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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 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. ❑ ❑ ❑ 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 applicable to the .roject 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 tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I \ Building \Permns\BUP- RES- PcrmitApp doe 03/21/06 440-4613T(I 1 /0JCOMM'EB) Electrical Permit Application„ FOR OFFICE USE ONLY City of T igard �' : ;_ . .J ;)� Date/By � ,Kti raoll, 7-O�l 114 (�___ p Permit No.. q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C • Phone 503.639.4171 Fax. 503.598.196(1J G 0 2 2007 Date/By. Other Permit: TI G A IZ D Inspection Line: 503 639.4175 Date Ready/By Suns. 61 See Page 2 for Internet: www.tigard -or gov .- '' :.. , " " ` .? , \ '=c1f1 Notified/Method: Supplemental Information TYPE OF WORK' ...... -•- ;:•s.::ai PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whtems checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stones ❑ 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 SIZE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "I -3 ", . site address: ^^ ' 9 1 100HP or more. occupancy Job no.: Job i IBM) SO ` /A 1 410 -q• ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 71„„ n� 77z t 2 ❑ Health -care facilities ❑ Supply voltage for more than f ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: F . Y ❑ Service or feeder 600 amps or more. i ( i 1� 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 75.00 2 DESCRIPTION OF WORK (with above sq ft.) 40—_e / Limited energy, multi - family 75 00 2 or-4 __4'. • - ..i.' e" _ r residential (with above sq. ft.) S2rvtces or feeders installation, alteration, ai relorariot' a • 200 amps or less 80.30 2 - ®PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 • V _ = Name: f 7 f ice 401 amps to 600 amps 160.60 2 - . ���,1 fil �� 601 amps to 1,000 amps 240.60 2 :; • Address: / g i g/ a' 3--1,0 l � Over 1,000 amps or volts 454.65 2 City/State /ZIp - �j_ O� - fn Temporary services or feeders installation, alteration, and/or `i 4 Olt / G relocation Phone:) 31L� 7yz q Fax: ( ) 200 amps or less 66.85 1 : - . Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 . - _ intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, a d 7 1. 401 amps to 599 amps 133 75 _ 2 Branch circuits– new, alteration, or extension, per panel Owner signature---,.......—...-- Date: e Z O A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits without service or feeder fee, Contact name: first branch circuit 46.85 2 Address: Each add'I 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: , / energy panel, alteration, or Address: /I / 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 (I hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour , 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: • Print name: Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: Date: This permit application expires If a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\ Building \Permns\ELC- PermitApp.doc 05/23/06 440- 4615T(ti /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 0.A. '_ ' ;18- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation p HVAC ti ❑ 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- PermrtApp.doc 03/23/06 Plumbing Permit Application - FOR OFFICE USE ONLY City of Tigard Received 0 7 1 ' Date/By: 7 Permit No• t`e j 7• -00/110 114 a q 13125 SW Hall Blvd , T gard 0102223 ;, Plan Review Phone: 503 639.4171 \p 503.598.1960 DateBy. Other Permit No • 11 . - 1l TI G A R D Inspection Line. 503 639 4 S ) oul Date Ready /By lures RI See Page 2 for Internet. www.tigard- or.gov Aug © � + L Notified/Method: Supplemental Information TYPE OF -WORK . FEE* SCHEDULE �ta> � ❑ New construction ® oli =Demtion For special information use checklist �" �' �`� y Description 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 (I) bath 249.20 ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399 00 ❑Master builder Each additional bath/kitchen 45 00 0 Fire sprinkler ( sq. ft ) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: J2 k 7 i7/2 /,��t�y,1,� f Catch basin or area drain 16.60 City /State /ZIP: ! 1 ,`� O d !� 7 - 772. r l r" Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ? I Project name: r . Jg �� ! " Footing drain (no. linear ft : ze-+) Page 2 Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16 60 Sanitary sewer (no. linear ft. ) Page 2 Storm sewer (no. linear ft.: ) Page 2 - -- Subdivision: I Lot no.: Water service (no. linear ft _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 telex!: . P,X. i' ►1 K TcLewt ✓ r C . J Backwater valve 16.60 ���� �'f Clothes washer 16.60 Dishwasher 16.60 1 PROPERTY OWNER I 0 TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: 111,004 r Expansion tank 16.60 Address: /z6 3 ' (A.210 4 Sf Fixture /sewer cap 16.60 City /State /ZIP: / o& 97j Z 3 Floor drain/floor sink/hub 16.60 Phone: (5: r z o _ `7L7 2 7 ' L) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60 I Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 Address: Other: I City /State /ZIP: V Sp Subtot: - Minimum permit feed Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: 36 25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: State surcharge (8% of permit fee) / TOTAL PERMIT FEE Print name: - 044 , ry ^ i� � Date: (6`9/07 This permit application expires if a permit is not obtained within J "'777 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i \ BuildingWPermits \PLM- PermitApp.doc 12/27/06 440-4616T( 1 0/02/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' 55 00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160 00 3,601 to 7,200 $220.00 • Sewer - I st 100' 55.00 7,201 and greater $309 00 Sewer - each additional 100' 46 40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46 40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55 00 $1.00 to $5,000 00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46 40 $5,001.00 to $10,000.00 $72 50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including specially requested inspections - per hour 72 50 Subtotal: $50 00 and up $742.00 for the e 0.00. first $50,000.00 and $1.20 for each additional $100 00 or fraction thereof. 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 Tub /Showr CI New exterior plumbing site utilities for any complex structure Bath - er Tub /Showerlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ 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. -4 Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial • Ice Mach. /Refrig. Drains Oil Separator (Gas Station) • Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory *Note: If the fixture work under this permit results in an -Bradley - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i \Building\Permns\PLM- PcrmitApp doc 12/27/06 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard '~ Ji Date/By: ecetved 0 07 Permit No 0 7 , ,,, .0 / ° 13125 SW Hall Blvd., Tigard, OR 97223 �'�–/ - 2007 Plan Review Phone. 503.639.4171 Fax: 503.598 1960 Date/By Other Permit. Inspection Line: 503.639.4175 T I GA It D p AUG G � D ate R ea d y /B Jnns El See Page 2 for Internet: www tigard -or gov o-•^;: i •, ' - ij Notified/Method Supplemental Information B .. 1% \!iaiil. 1 \i TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST ❑ New construction Addition /alteration /replacement 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: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ,l- 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 Job site address: Air conditioning or heat pump ��k Sir1 C j1i i (requires site plan showing placement) 14.00 City /State /ZIP: 'T 1 c2i-rf QR 9-7zZ X Furnace 100,000 BTU (ducts/vents) 14 00 f J Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: @ ������� Gas heat pump 14 00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: I Lot no.: Flue /vent for any of above 6.80 Other. 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 •_ ., _ � ' A v Gas fireplace 10 00 �� P E ti}7 '7) u t�T� Flue vent for water heater or gas ` I ( ate I fireplace 10.00 I sar. Log lighter (gas) 10 00 .. Wood /pellet stove 10.00 j ._ -. ; Wood fireplace /insert 10 00 i� PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00 Other: 10 00 Name: 7j, , j', R Environmental exhaust and ventilation Range hood/other kitchen Address: /2�c Jb t��N /0 Sf , equipment 10.00 City /State /ZIP: 7 a / O c 7z 3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: )3 0 —714 Zt 1 Fax: ( ) toilet compartments, utility rooms) I 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: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other Address: Sir • MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Minimum permit fcc ($72.50) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature �� This permit application expires if a permit is not obtained within 180 J days after it has been accepted as complete. Print name: 7 11 ry ,Z A „ Date: *427 • Fee methodology set by Tn- County Building Industry Service Board I t Building\PermitsN1EC- PermiAppdoe 01/19/077 440-4617T(11 /02/COM/WEB) Mechanical Permit Application - City of Tigard PP Page 2 - Su lemental 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 REf AUG m6r 012-7- 0 6 2007 CITY Of 'fi jARD BUILDING DIVISION 28' -6 32' - 5' 26' -712' l6' -4' 2' -1L- DECK 6 58' -3' 8' -Oit' OVERHANG 24' 23 -7• 1:4' :11.-- ' ADDITION 8' I' 22' 4' 17' - -- 0'-` 22' -4' DRIVEWAY PROPOSED SITE PLAN 12810 SW Walnut St. Tigard, OR 97223 TOM AUGUST 503.320.7424 08 -04 -2007 90'