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Permit
CITY OF TIGARD MASTER PERMIT ,.. . .., • .2 : COMMUNITY DEVELOPMENT Permit #: MST2013 -00039 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/04/2013 Parcel: 1 S 134ACO2646 Jurisdiction: Tigard Site address: 11040 SW COTTONWOOD LN Subdivision: ENGLEWOOD NO.3 Lot: 212 Project: Swearingen Project Description: Bathroom remodel BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $25.000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits . 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 ' Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3 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 8 Stereo: N HVAC: N Security Alarm N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 0 Owner: Contractor: SWEARINGEN, LARRY DAVID E BRENNER Required Items and Reports (Conditions) ROBERTA 15740 NW NORWICH ST 11040 SW COTTONWOOD LN BEAVERTON, OR 97006 TIGARD, OR 97223 PHONE: PHONE: 503 -819 -1373 FAX: Total Fees: $1,069.03 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 a • - • - with approved plans. This permit will expire if work is not started within 180 days • . — _ - - or if work is suspended for more the 180 days. • NTION: Ore• • law -quires you to follow the rules adopted by the Oregon Utility Noti ication Cent- . Those rules are set forth in OAR 952 -01 -0010 through OAR 9 .- • 01 -0r ou may obtain a copy of the rules or direct questions to OUNC by calling 503 32.198 • 1.80• Issu- • By: j a P ermittee Si nature: /l g Call 503.639.4175 by 7:00 a.m. for the next available inspectio • ate. - This permit card shall be kept in a conspicuous place on the job site until co • - n of the project. Approved plans are required on the job site at the time of each inspection. Building Perm Applicatio Residential FOR OFFICE ESE ONLY City of Tigard FEB 21 2013 Date/B : c� Sa l " Permit No.: fy< /p 3' • 13125 SW Hall Blvd., Tigard, OR� OF Plan Review ► - A Phone: 503.718.2439 Fax: 503.5 Plan R : , .t� `7 Other Permit: M G ,� R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: I- 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. g I- and 2 -famil dwellin Valuation: $�5 l�D0 y g ❑ CommerciaUindustrial V ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / fo y0 5,� C/ " , �()�7' (o�j hi, New dwelling area: square feet City /State /ZIP: ` Ti 1 27? 972-z-3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: s „ ems ikL2%/ / 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 (rotnded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. t a- 1,1 X12014( Wei( fr e,ijf i'l Valuation: $ Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: JIZI APPLICANT � ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: p�{/i fj . _NI7j� (Please refer (or fee schedule) Y i� � �jJ ,` Structural plan review fee (or r deposit): Contact name: W Address: L� l / !wt' AR', i (-4- V/c FLS plan review fee (if applicable): City /State /ZIP: G Total fees due upon application: 7 q Fax: / /,,,7 S° /� Amount received: r�5. / Phone: (3) �� / / �3 : (� fyl�< �� a ly,di,,�J�,~ --- `i � PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: �'�" \A Cr t Commercial and residential prescriptive installation of CON CTOR roof -top • nted PhotoVoltaic Solar Panel System. Business name: // 4� ��71/ye� Submit two (2) of roof plan with con - ' • details /� A � � � C and fire department ss, along .• . I e Oregon Address: L U 7 Solar Instatallllaation Specia . e checklist. City /State /ZIP: Q� P7, 17z52eZ Permit Fee (incl • -s p eview $180.00 (5�) el? 7 ( ) 9 % / and .rmi o m Phone: Fax: � State surch.. ge (12% of permit fee): $21.60 CCB lic.: ! . feA / Total fee due upon application: $201.60 / Authorized signature: / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Print name: ` //P .4, ��j(//47 Date: 7t7 Service Board 1:\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440 -4613T(1 I /02 /COM/WEB) • Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ()NIA City of Tigard Received Date/By: No,: Ill to 13125 SW W Hall Blvd., Tigard, OR 97223 Associated permits: el Phone: 503.718.2439 Fax: 503.598.1960 I' I G A It 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 l'es 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 Fr sion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin rotection, etc. 10 3 C mplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ • ing 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. 1 I 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 d 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 Ore _on and shall be shown to be a• elicable to the •ro•ect under review. .JURISDICTIONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and 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:\ Building \Permits\BUP - RESPermitApp.doc 02/ 24/2011 440- 4613T(1 I /02 /COM/WEB) KtCt 1Vtll Plumbing Permit Application B Building Fixtures r - 2 1 2Q13 FOR OFFICE USE ONLY City of Tigard CITY OF TIGARD Received # pt ! _ ' Permit N °.: 45,- � n 13125 SW Hall Blvd., TigaraING DIVISION Phone: 503.718.2439 Fax: 503.598.1960 a Review Date By: Other Permit No.: TIGARD Inspection Line: 503.639 Date Ready/By: lugs El See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total c lA Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 jt 1- 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 El Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: //.747 5 , Z ) - impee id/ • Catch basin or area drain 18.76 City/State /ZIP: 7 , � 3 F otin drain line, or e trench drain ag 2 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: 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 s/�l /N,p c��/ A,� // Clothes washer 25.02 /ff6'a �� er It � /�% / // �'�-84 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ti APPLICANT El CONTACT PERSON Interceptor /grease trap 25.02 Business name: /v L l eA / � l Medical gas (value: $ ) Page 2 p l n Primer 12.51 Contact name: [ i Roof drain (commercial) 12.51 ��� Address: /5 �� /�gj'j�f/ � Sink/basin/lavatory Z 25.02 City /State /ZIP: -0.1� "9 '5 Je‘ Solar units (potable water) 62.54 Phone: ( gyp ) 879 /?7 Fax: : b3) 3yj 1,,,V Tub /shower /shower pan i 12.51 E -mail: /(139,p1/7&/- e Pl k Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: �l �jLGo Water piping/DWV 56.2 Address: 7 3 5;41 , 5/ IF 4,,, Other: 25.02 City /State /ZIP: �17 i f 9'2/9 Subtotal Phone: ( %) L rzy Fax: ( ` ) Minimum permit fee: $72.50 CCB Lie.: /9/ = 8(P/ �� Plumbing Lic. no.: J ' u Plan review (25% of permit fee) 7 ' / l/ 1 State surcharge (12% of permit fee) Authorized signature: % / /�� TOTAL PERMIT FEE Print name: I �J �y ` Date: �,. /� This permit application expires if a permit is not obtained within 180 days i after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permils\PLMU- PermitApp.doc 10/01/09 440- 46I6T(10 /O2ICOM/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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $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 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 ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower - Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918 -780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings - Car Wash Drain that meet the qualifications above. Garbage - Domestic non -food Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach./Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: - Lav/Bar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes Water Extractor fees assessed for the sewer increase must be paid before the WaterCloset - Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2 RECEIVED Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard FEB 2 1 2013 Date/By: , !� Permit No.: )5 , / 6... 3 " Ili 13125 SW Hall Blvd., Tigard,OR 97223 � C Phone: 503.718.2439 Fax: 503.598.1) OFTIGARD Plan Review Other Permit: Inspection Line: 50 3. 63 9.4175 DateBy: T I G A R D p BUILDING DNISION Date Ready/By: Juris: El See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Id 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 Cry RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ,i 1- and 2- family dwelling ❑ Commercial/industrial cc ory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: // (074-729,7k., �j � Air conditioning L/ Job site address: 0yO $ Ui 1�. v (requires site plan showing placement) 46.75 �� /' ^/ �j Furnace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: / / (Y t ' ' s 3 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: / Project name: S4i *I 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 Subdivision: 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 -�/ Air.r "/ .i. �..l.d. i ' Flue vent for water heater or gas L -or fireplace 23.32 fir' � � � �� ���5 / i Log lighter (gas) 23.32 //Re( 7 %� /� Q� , Wood/pellet stove 33.39 e&e,,G /� Wood fireplace/insert 23.32 ❑ O PERTY 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 A APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: e!d,r/�/� Other: 23.32 Fuel piping: Contact name: Drfv / l7 $14.15 for first four; $4.03 for each additional /5,W w � «, ,�/ 1,e . / ' Furnace, etc. Address: y ,Ma./, /r' !/l'7 pps�i Gas heat pump City /State /ZIP: v � D � Wall /suspended/unit heater f!l Phone: ( ) 9 t/373 Fax: ( IV ) /B� Water heater ,�1, e , -/ �/ 'P Fireplace E- mail: ��,. GC���y ,� s /�L�e Range CONTILACTOR Barbecue Business name: Pilt4 p ,� "Le.ri.ve-T Clothes dryer (gas) �7 Other: Address: /5 /l ', � —1 --W9/6 5/ MECHANICAL PERMIT FEES* City/State /ZIP: reg eGi .*' 9 w, Subtotal Phone: () 0/9 Fax: ( ) 7 �j-' !g Minimum permit fee ($90.00) 3! y� Plan review (25% of permit fee) CCB lic.: /97 9 State surcharge (12% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature �� days after it has been accepted as complete. Print name: �..,�� -� Date: 2� /Z • Fee methodology set by Tn -County Building Industry Service Board 1: \ Building \Permits\MEC- PermitApp.doc 03/07/12 . 0-461 (1I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: 'Total Valuation: °`n •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: \ BuildingTermits \MEC- PermitApp.doc 03/07/12 2 iWV_ .. Electrical Permit Applicatiokg 21 2013 111111 Received �,�/ City of Tigard OFTIGARD Date/By: / p / / ,9 Permit No.: � 5 -WU' • 13125 SW Hall Blvd., Tigard, OR < [VISION Plan Review r G D Other Permit: Phone: 503.718.2439 Fax: 5(B.. ' •: Date/By: Inspection Line: 503.639.4175 Date Ready/By: lads: 63 See Page 2 for T I G A R D Notified/Method: S Internet: www.tigard- or.gov Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: //pro 3' �, 67-#0, ❑ I Six or more. occupancy. Six o or r more residential units. ❑ Recreational vehicle parks. City/State /ZIP: / /p fe, f - Z - Z-- 3 ❑ Health -care facilities. ❑ Supply voltage for more than / ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt no.: Project name: $ /g ie �� ❑ Service or feeder 600 amps or more. G 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 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 - I Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 /` Limited energy, multi - family / /fr / /0 g � © j - li � j��� *a ," G residential (with above sq. ft.) 75.00 2 / / • C 7i �/ J Services or feeders installation, alteration, and/or relocation . S , e et �V/ 7j k� 200 amps or less 100.70 2 � � OPER OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps 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 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 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with jil APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: `tea ' ! 'f li B. Fee for branch circuits without I service or feeder fee, first / Contact name: pew CD AftL� / branch circuit 56.18 2 y Each add'l branch circuit p____ 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty 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 circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 !mot r ��� LNG , Each additional inspection over allowable in any of the above Address: _� , �Q?C f i ?, ( Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: ;P -- e7`L, 7025.2 Industrial plant (1 hr min) 78.18/ hr Phone: 53) 26 7 aax: ( ) /4/. 3 Inspections for which no fee is 90.00/ hr specifically listed (%2 hr min) CC: L' 0.0 _ial l Lic. / i , • ELECTRICAL PERMIT FEES Su.rv. le trician signs ./ t .. �� Subtotal: — ii � — Plan revi (2 5% of perm fee): Print name: c ,. t. rC Date: z __ 1 3 State surcharge (12% of permit fee): i c Jr_ ee �C / _ TOTAL PERMIT FEE: Authorized signature: l This permit application expires if a permit is not obtained within 180 Print name: Date: — • days after it has been accepted as complete. Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doe 07/01/10 440 -4615T(11 /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: S ;RESIDENTIAL\WORKIONLY :74 L :;F 'W:gi 4. 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* El Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls El Clock Systems El Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical ❑ Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: Building \PermitAELC- PermitApp.doc 07/01/10 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 11040 SW COTTONWOOD LN, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 04/10/2013 00:00 MST2013-00039 PASS Bert94@comcast.net 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 11040 SW COTTONWOOD LN, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical final 04/10/2013 00:00 MST2013-00039 PASS Violation Summary: Inspector Contractor