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Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 I11 T I GARD October 24, 2008 Matthew Johnson 13245 SW Falcon Rise Dr. Tigard, OR 97223 Re: Permit No. MST2008 -00125 Dear Mr. Johnson: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 13245 SW Falcon Rise Dr. Project Name: Johnson Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $530.89. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per owner's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. • I: \Building\ Refunds\ Administration \LtrRefund- CancclPermitdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 . _ " City of Tigard Tidemark Refund Request TIGARD This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Matthew Johnson DATE: 10/24/08 13245 SW Falcon Rise Dr. Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 2008 -3299 Case #: MST2008 -00125 Date: 9/19/08 Address /Parcel: 13245 SW Falcon Rise Dr. Pay Method: CreditCard Project Name: Johnson EXPLANATION: Per owner's request as job was cancelled. Refund 80% of permit fees. REFUND INFORMATION: . . Fee Description From- Receipt. Revenue Account No • Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000. . • $ Amount . - [BUILD] Bldg Permit 245- 0000 - 432000 $315.20 [TAX] Bldg 12% State Surcharge 100 -0000- 207020 37.83 [MECH] MEC Permit 245 - 0000 - 431010 58.00 [TAX] MEC 12% State Surcharge 100 - 0000 - 207020 6.96 [PLUMB] PLM Permit 245- 0000 - 431000 58.00 [TAX] PLM 12% State Surcharge 100 - 0000 - 207020 6.96 [ELPRMT] ELC Permit 220 - 0000 - 431510 42.80 [TAX] ELC 12% State Surcharge 100 - 0000 - 207020 5.14 TOTAL REFUND: $530.89 APPROVALS: If under $500 Professional Staff �,5 , ,� V If under $7,500 Division Manager ,r / "�... ; i / If under $22,500 Department Manager f If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE'ONL L� Case Refund Processed: I Date: I ii /�‘/�',F I By: I / I: \Building \Refunds \RefundRe.iuest.doc 05/23/07 1. +12.5.:\%• 11:11 I:i..l. -. I;!; :tr.l.km. 't7_'_'; 311.1..,3 71 ; .: ti +.:d s1'..!2 ei+)t #: 272( O$O 90009001093671A.1'...-V-5111--d--.- _ Bate: 1()/24/2008 :.inr I :.•0. ;: c:a;e No . 1 . 1.mi ('.n1e Iie;eri Revenue: \cenunt \u Amount 1'a6(I \ -UUI25 Reversal- LI(UILI)]I(IdfPermit 245-0000-43'000 (315.20) \Ij1'11;11- 11111'5 le,eve1';a1 -I . \ \I Ituild 12%St :1 !(I0- (1(11)1)- 21)71) (37.13) \IS 20U<- (H)!25 Revers :11 - [ :Ml C'III Mk(_ Permit 245- (1000 - 4311)10 (58.00) \•I :;"1 -00 1 25 Revers :11 - [TAN] i \I IBC 12% State 100-0000-21)7020 (6 96) IS 00S -00l25 Reversal - [l !..l.J1\'Ifi] I'LNI Permit 245- 0000 - 4311)00 (51.00) NIS'f '00s -001 _'5 Reversal - I. 1 \. \] I'L1M 12% Stale IOO- (1(10(1 - 2070 O (6.96) \IS]'2t) )ti- 01)125 Reversal - [ I I_I'RMI] ELC Permit 220- 0(100 - 43 1 5 1 0 (42.10) \!l 1 \- 0III2i Bevers :Il - [TAN] ELC I % Stale 11/11-011 (5.14) Line new 'IUIal: (S53l).1') 15 ...... 1 : l..t•.oa l'a%er • (;e• II) :\eet. /Check:: \u. Approval \u. It % l:rrcicet1 Antolini t'ai(I .. 1 '...v•crs:1l :\1A • I )I I.`:i'.)\ 1) ?u In Person (53().10) . Rel Tot :II: (553 ' c (:V O O a) 0. '� C w N v v aE •G C� o L a 1~ .4 a _ O � i °� x y `i C v a Q + c A t l . r 3 v W o .. m O K � 1 a cn . 5 , ...N. a o . ,x 01 „U W w q x . 9. y 0 v ai v> .� Q o ° Qo4xU 20 a u. •_ c a) a ,. ,, Q r--, O N J W / Li... Ix a 1 C TY OF I GARD 10 16!2o4)s, A rrAt 13125 SW flail Blvd. I :07:22 PM .7 1::: 12 j - ' Tigard, OR 97221 5113.619.4171 Receipt #: 27200800000000003299 Date: 09/19/2008 Line Items: Case No Tran Code Description Revenue Account No A Paid MST2005 -00125 [BUILD] Bldg Permit 245 - 0000 - 432000 394.00 MST200S -001 25 [TAX] Build 12% State Surchrge 100- 0000 - 207020 47.28 MST2005 -00 1 2 5 [MECH MEC Permit 245 - 0000 - 431010 72.50 MST200S -00125 [TAX] MEC 12% StateSurchartie I00- 0000 - 20702(1 8.7() MST200S -00125 [PLUMB] PLM Permit 245- 0000 - 431000 72.50 MST2008-00125 [TAX] PLM 12% State Surcharge 100- 0000 - 207020 5.70 MST200S -00125 [ELPRMT] ELC Permit 220 -0000- 431510 53.50 MST200S -O0125 [TAX] IT LC 12% State Surcharge 100 -0000- 207020 6.42 Line Item Total: $663.60 Payments: Method Payer User ID Acct. /Check . \o. Approval .. \o. flow Received Amount Paid CreditCard \ • . • M BTT 024729 In Person 663.60 '_ . RS I NC. c`f Payment "Total: 1663.60 • Thursday, October 16, 2008 12:11 PM Equine Facility Design 503 -650 -5862 p.01 CE Community Development OCT 16 2008 TIGARD Request for Permit Action CITY OFTIGARD BUILDING DIVISION TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Plt ?nr.: 503.71 H 2430 Itax: 503.598.1960 www.rigard-or.gov FROM: ® Owner .Applicant ❑ Contractor ❑ City Siaff ( n,tr:) R O + R. Name: Matthew Johnson INVO rr INVOICE 1 O: (t urine er urludividual) • Mai ling Address: 13245 SW Falcon Rise Drive V ®I D City/State /lip: _Tigard, OR 97223 Phone No,: - 503- 524 -509(1 PLEASE, 'FARM,ACTION FOR THE ITEM(S) CHECKFI) (✓): ® CANCEL PERMIT APPLICATION. ® RI-A-:1; ND FEI -'ti (attach receipt, il' available). ❑ INVOICE F'012. FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CON'IRACT()R FRC)M PERMIT (do not cancel permit). 1'crmil #: MS'l'2008- 00125 Sire Address or Parcel. V.: 1 S133D(; 01800, same addres as above Project Name: Bedroom. and Bathroom. Addition Sttbdivi titiri Name: Morning Ilill I .ot ft: 46 EXPLANA'rION: Project canctticd due to econorntc down fall. ,V 7r: %'CFp• 4/S Tee .... 7!777.. . - t /'/ E22o1L. n ^ I , �l= • Signature: ,1% - - Dace: 104 G -118 • �" ..1. a • hcw _Johnson Pr Name: jlrlin.d PI liry L The Director or ) uidiup, C may authorise to rcfuud of a) any fee which was erroneously paid or cnllrrrc d. Ir) nut anon: tlh;w 80% of tLe Lind use application fee when au eppliuuun is withdrawal or canceled before. any review effort ha.a her., erpn,ded. r.) not more than IW ot the land use applirarinn tiee to. issued permits. d) not more than S(t . ct the building plan eevirw tar. when a., Seri ..tion is canceled heh.,r :+ny Ids., n:v.,:w .•ff..,r 1,.. L,, ., .•.lu ,.d.d. .) out ua.a Wan 8•Y'!•. c•i W. Lvil.l... p..avit h... Luz ia.v•d pamai.s pens to aay ia.pauti.,a ..que.,a. 2. atefunds will be =turned to the original Payer in the same method in which payment was received. !'lease allow 1.2. weeks foe piocessing refunds. • oft •OI . I . C.I l of ONf,1" . • Rre to Sys Admin: Dnre So f -T 1; _ T kte BI A 1)ttte /, Round Processed: Dan: i� r _ . / Invoice Processed: Date ' B Permit Canceled: Date O LN c By /' A -Parcel Tag Added: �. Dare Fly Receipt #01 Date ` / f /� oe Method C Amount $ 1! \siddiug \I'.,,.,,z.\ KcgYcunirActino.dnc v(17 /26/U7 _ '{ •I 9 9 a CITY OF TIGARD ASTER PERMIT PERMIT #: MST2008 -00125 ° ` COMMUNITY DEVELOPMENT DATE ISSUED: 9/19/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133DC SITE ADDRESS: 13245 SW FALCON RISE DR ZONING: R -7 SUBDIVISION: MORNING HILL NO. 1 LOT: 046 JURISDICTION: TIG PROJECT: JOHNSON Project Description: Bedroom and bathroom addition. BUILDING ' REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: of BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: at GARAGE: of FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: at RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 35.000.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: 1 VENT FANS: 1 CLOTHES DRYER: ELE FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 1 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAUPANEL: IN PLANT: MANU HM /SVC/FDR: 601 - 1000 amp: 601•amps- 1000v: MINOR LABEL: 1000+ amp/volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS ARENSPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO a STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPERRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable MATTHEW JOHNSON WOODMASTER NORTHWEST INC laws. All work will be done in accordance with approved plans. This 13245 SW FALCON RISE DR 46363 SE WILDCAT MOUNTAIN DR permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 SANDY, OR 97055 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 -524 -5090 Contact #: PRI 503 668 - 0443 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: LIC 54460 TOTAL FEES: $ 919.70 REQUIRED ITEMS AND REPORTS 1111V I itilligiral Issued B -#-- %• Permittee Signatur : 1111'11111►11 I 41111` i'{• Call 503.6 • ..1 •y 7:00 a.m. for an inspection that busi - day. 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. �5 Scel ��/ 0.1) , ' 0 Building Permit Application '' Residential FOR OFFIC E USl oLY City of Tigard `icr0.10 Dane Perm No.: .r�0 I3125 SW Hall Blvd., Tig p Plan Review Q /' C Phone: 503.639.4171 Fax . 60 4 1 11 Dale/By: I • 1.0 other Permit: l I G n I: D Inspection Line: 503 A ti�� O Date Read ® See Page 2 for Internet: www or.gov 1� A� Notified/Method: /1 r Li I d� . S upplemental Information . TYPE 0 • , REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction �z • molition 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. ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $35,000 ❑ Accessory building El Multi-family Number of bedrooms: 1 ❑ Master builder ❑ Other: Number of bathrooms: 1 'JOB SITE INFORMATION AND LOCATION . • - • Total number of floors: Job site address: 13245 SW Falcon Rise Drive, Tigard, OR New dwelling area: 213 square feet City/State/ZIP: 97223 Garage/carport area: square feet Suite/bldgJapt. no.: I Project name: Johnson Residence Covered porch area: square feet Cross street/directions to job site: Morning Hill Drive Deck area: square feet Take Scholls Ferry Road West to I35 turn left onto I35 continue to Morning Other structure area: square feet Hill Dr. and turn left, continue to Falcon Rise Drive and turn left REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Morning Hill I4 . (' Lot no.: *(p Permit fees' are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: t ( DCO le, op equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. New bedroom and bathroom addition to existing residence Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: • Name: Matthew Johnson Type of construction: Address: 13245 SW Falcon Rise Drive Occupancy groups: City/State/ZIP: Tigard, OR 97223 Existing: • Phone: (503)524-5090 Fax: (503)650 -1663 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 applicant is exempt from licensing, the following reasons City/State/ZIP: apply: Phone: ( ) I Fax:: ( ) E -mail: CONTRACTOR Business name: Woodmaster Construction Inc. BUILDING PERMIT FEES' Address: 46363 SE Wildcat Mountain Drive n (Please refer to fee schedule) Structural plan review fee (or deposit): oX 'IC) City/State/ZIP: Sandy, OR 97055 Phone: (503) 668-0443 I Fax: ( ) FLS plan review fee (if applicable): CCB lic.: 054460 OM Total fees due upon application:? Srp . t Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. I Print name: Matthew Johnson I Date: 844-08 • Fee methodology set by Tri -County Building Industry • Service Board. I:\ Building \Permits\BUP- RES.PermitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY Received X City of Tigard Date /By: 0 i5 /va g Permit No.:� Cr , w /�j5 • 13125 SW Hall Blvd., Tigard, OR 9 72 Plan Review •J/ C c eNt. Other Permit: Phone: 503.639.4171 Fax: 503. Date/By: "1" 1 G A It D Inspection Line: 503.639.4175 o oU Date Ready /By: Juris: RI See Page 2 for Internet: www.tigard or.gov 1 �, Notified/Method: ' Supplemental Information TYPE OF WO ' . _ 4 �� 1 ` �' O� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction Addition/altera .�► `�,1 Mechanical permit fees* are based on the value of the work 8� + performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑Other: V mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 14 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder 0 Other: Description I Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 1•3iAb SW Qt,(QN S.4 Dy24 YE. Air conditioning or heat pump (requires site plan showing placement) 1 14.00 City/State /ZIP: 116-NO . O . 011,23 ,�`�cc a 1 Furnace 100,000 BTU (ducts/vents) 14.00 g P 30 1MM NAilli1� Furnace 100,000+ BTU ( ducts/vents) 17.90 Suite/bld /a t. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: M��P11N6NIL1. Dr. . Duct work Q/ 10.00 1L 1' OU. Hydronic hot water system 14.00 SCAMS Y 1'O 1391W lb 6snO RNIN(, 11-1u- b �p Residential boiler (radiator or 16 Met0k 1 VASE D . hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Flue/vent for any of above 6.80 Subdivision: MOINfj t� NO- Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 3 bift - OM MJ1t 13.MAR -0 OM Ab 1014 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ////3 PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 10.00 �� Other: 10.00 Name: MATT 30SO N b' . Environmental exhaust and ventilation Address: 1324 SW rM,CQh1 �1$. b'1 1 . Range hood/other kitchen equipment 10.00 City /State/ZIP: TIGIA . Og 1111,3 Clothes dryer exhaust 10.00 ( 503) C j4. 50° 0 Fax: Single-duct compartments, rtm ents (bathrooms, Phone: ( ) toilet compartments, utility rooms) 1 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: e(//irc4,--- 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) CJLAi• � Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 71,• SO Plan review (25% of permit fee) CCB lic.: State surcharge (12 %ofpermit fee) x .70 A . I i TOTAL PERMIT FEE I Authorized si t . ‘C11 ' l This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: tor$"�1N 1\\M(514 Date: 1� , O 8 Fee methodology set by Tri County Building Industry Service Board 1:\Building\PermitsU%1EC- PermitApp.doc 01/ 19/07 440- 4617T(I1 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information �1;;� • ,; ; Commercial Fee Schedule: 80E . 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 1VI c UMII additional $100.00 VI 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 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 • • Electrical Permit Application FOR OFFICE USE ONLY City of Tigard ' � DateB e a �� JJ Perm No.: A - ..--0() ` ' ° I3I25 SW Hall Blvd., Tigard, OR a C Plan Review 1 C . Phone: 503.639.4171 Fax: 503.59:1 l ". i e q00� Date/By: Other Permit: I A R 17 Inspection Line: 503.639 ^UG 1 J L Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard or.gov I' 1 / 4 0 � , �ap Notified/Method: 77-0 Supplemental Information TYPE OF WO) it `O - PLAN REVIEW ❑ New construction Addition/altera 0 � �- 1 V` Please check all that apply (submit 2 sets of plans w /items 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- 2- family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. Multi- family 0 Master builder 0 Other: 0 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 ", "I -2 ", "1 -3 ", Job no.: Job site address: 177 SW VisAat4 WSJ Dg , 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 'la?.. 0e q1 Z2-3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 300 MS 614 1,1 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: M6 (N6 \-Ii,l, .14.01. Dneription I Qtr. I Fee. I Total I • 0 New residential single- or multi- family dwelling unit. SCAM SCAM r5 Y .--) 1351 M �� OclU- - �Q�(, Includes attached garage. Mty git46 W t NO Subdivision: f � W 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.) •1 D�?6 D,, $ �r �rOO M Pt A trlO t4 Limited ei energy, (with above s multi-family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: Wlb,11 30tMot■i. 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 07,45 SW r ,tON its. Dp- • Over 1,000 amps or volts 454.65 2 City/State /ZIP: ' 161%,le,p . pg. crivi,3 Temporary services or feeders installation, alteration, and/or relocation Phone: ( fj Cj j4 l' 0 Fax: ( ) 200 amps or less 66.85 I 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, le r t, or a l change, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: $' 15 O$ Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: at B. Fee for branch circuits Contact name: without service or feeder fee, , I 46.85 2 first branch circuit Address: Each add'I branch circuit 1 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 Business name: Signal circuit(s) or limited - _,01./". energy panel, alteration, or Address: 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 (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 53 .60 Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): (.p • 42. Authorized signature: ----- TOTAL PERMIT FEE: Print name: 1,AIMIAVAA) aO SON Date: 8 . f . 0 S 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. I :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(II /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: r COMMERCIAL WORK ONLY: Fee for each 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 ❑ HVAC ❑ 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 1:\ Building \Permits\ELC- PermitApp.doc 03/23/06 Plumbing Permit Application Building Fixtures 5� FOR OFFICE USE ONLY CI of Ti and Received Tigard i N Permit o.: u 13125 SW Hall Blvd., Tigard, OR + . Cal Date/By: f) Kr Mr &.-- 01.5"---- g Plan Review C Phone: 503.639.4171 Fax: 503.5' 8.1960 1 2OOv Date/13y: Permit No.: Inspection Line: 503.639.4175 0 T I G A K D O Date ReadyBy: Juris: El See Page 2 for Internet: www.tigard- or.gov otifie 770 Supplemental Information TYPE OF WORT ®1∎4400 FEE* SCHEDULE ❑ New construction �;�u; s ; __ W F or special information use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 Vf 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen , 45.00 }� ❑ Master builder ❑ Other: /' Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: '?17,4 Sys/ rb1,CQ14 R1S DA - Catch basin or area drain 16.60 City /State /ZIP: 116 Wt.- 0c ct i iii Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 3046)4 { A xO tlitq Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job job site: Ma (N(� O O .. - b Manholes 16.60 SCAMS r �� % 1 W11\ MOM14(, Fib/µ .D F . Rain drain connector 16.60 SW tl-G USN �Se lAz-. Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: M D��1Nf - �'L .& 1 Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: l � Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 • 14 %A tiMA Ism V7 --OAA AfbcA 1 csk4 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 VI PROPERTY OWNER Drinking fountain 16.60 ❑ TENANT Ejectors /sump 16.60 Name: W,-cr AO Wt4W4 Expansion tank 16.60 Address: 1 S W rt 4 pS v pv., Fixture /sewer cap 16.60 City /State /ZIP: -(1(, p1-j Z2,?) Floor drain/floor sink/hub 16.60 Phone: ( 03) C z,4. C 050, F ax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 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 • Phone: Sink/basin/lavatory 1 16.60 ( ) Fax: ) . Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet I 16.60 Business name: r,M �/�r- Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: 5172.511 72 �� Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: ` Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signatur I i I I � l � � � � I State surcharge (12% of permit fee) $ .7 0 .f TOTAL PERMIT FEE Print name: MbTt4IrFi1N S Q>MASA`A Date:% As" - ag This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(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' 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 - 1st 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 additional $100.00 or fraction thereof, to and Fixture or Item Q ty. Fee (ea) Total 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 specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixture s could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram • Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" - 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 - Bradley *Note: If the fixture work under this permit results in an - 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 \Permits\PLM- PermitApp.doc 12/27/06 • EINIIIPINININIII WWI Information Notice to Property Owners About Construction Responsibilities Statement Oregon Law requires residential construction permit applicants who are not licensed with the 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 and complete the following statement: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or l>1 I 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, 1 will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I have read and understand the Information Notice to Property Owners about Construction Responsibilities contained on these two pages and I hereby certify that the information checked and completed above is correct and accurate. i , I I , 1 1 11 , i 1\AI c 4a Lielleirtfilk V V Print name of permit applicant ? re o permit ap 6 Date Permit #: ( IF--00 g This form is supplied to building -fat., 13),1 5 " ) /�+ /coyv ��e Or offices by the Oregon ''� Address: .iir Construction Contractors Board, = "y` = �` as required by ORS 701.055 (6) ��.�. ' N t rdf the 170 Issued by: T Date: SA This copy to issuing permit office czflLl 9 4 - V9L1L d h() )'A MS *z i go S NO\ \a4N Nc S OV \\D 1 .0 3 0.49 "A t - �o l')1 41S 0b.\ i s Wool • Yt'W �X 1 N � City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 TIGARD October 24, 2008 Matthew Johnson 13245 SW Falcon Rise Dr. Tigard, OR 97223 Re: Permit No. MST2008 -00125 Dear Mr. Johnson: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 13245 SW Falcon Rise Dr. Project Name: Johnson Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $530.89. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per owner's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. • 1: \Building\ Refunds \ Administration \LtrRefund- CancelPemvtdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 Thursday, October 16, 2008 12:11 PM Equine Facility Design 503 -650 -5862 p.01 RECEIVED ;� ° Community Development OCT 16 2008 TIGARD Re for Permit Action CITY OF TIGARD BUILDING DIVISION TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phu one: 503.718.2430 Fax: 503.598.1960 www.t;gard- or.gov FROM: ® Owner .Applicant ❑ Contractor ❑ City Staff (check nor.) KF:1 OR. Name: Matthew Johnson INVOICE TO: (IheinreeorIndividual) Mailing Address: 13245 SW Falcon Rise Drive VI 1 D (:toy /Sta.te /Zip: Tigard, OR 97223 ofr if Q Phone No.: 503 -524- 509() PLEASE TAKE ACTION' POR THE ITEM(S) CHECKED ( ✓): El CANCEL PERMIT APPLICATION. • RI-: UN1) 1 ?F'RMI'l' F'F.HS (attach receipt. if available). ❑ INVOICE FOR. FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CON.RACTOR FROM PERMIT (do not cancel permit). Permit #: MS'1200g••00125 Sire Address or Parcel. if: 1 S133DC (.11800, same addles as above Project Name: Bedroom and Bathroom. Addition Subdiviwiou Name: Morning Ilill Lot t/ : 46 EXPLANATION: Project ca.ncek:d due to economic down fall. ,v''7:: R E e , 0 7 e r, L/s T a . C o A v r e _ r a r t . 9s / / g y m :,1 572,24-fL • Signature: .k: Date: 10 -16 -08 Mathew Johnson Print Name: R. .lin.d P 1. Alt Director or )iaIldinp Official may authorize the refund u£ a) any fee which was erroneously paid o cr.11ected. b) nut more Ian 80" /i oldie laid use application fie when an application is withdrawn or canceled before any review elfnn this heel expended. c) nor more than KW. of the land use °phiicarine fee for i4ated permits. d) nor more than 8O% of the building. plan review the whew an ai>plie..tion is err i d t.efotr :+oy l.lan ,,,i .. v rff .,r 1... L.•. u . spy .d.d. . ) nut .....s Wan 8SY`f•. ui i6. buitdisq; p.m.it l.. LYE ian..d p.m.hs pons to any ia.p...•tiun wqu.eta. 2. ltefoohs will be returned to the original Layer in the same method in which payment was received 1'lease allow 1.2 weeps for proce•.sing cclmiits. r(:)R 01'14 CiT I. S1 ONO" Rro to Sr Adman: Dan! t . L. ^ � , P It.te to cal ndmiry .Date /. x De r Refund Procasscd: i)ate faig o� ti /••?' Invoice Processed: Date B Permit Canceled: Date /0 b4 ad-- By •1 "• Parcel Tag Added: D ate Fly Recci • t # orb' , Date 7 /q •, Method c� A moLLnr $ I:1 til ting \l'non AitcgPcouirActioo.doe :07/24/07 s eX5g- 3 2Q9 111111 ,.. ° City of Tigard T 1 GA RD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Matthew Johnson DATE: 10/24/08 13245 SW Falcon Rise Dr. Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 2008 -3299 Case #: MST2008 -00125 Date: 9/19/08 Address /Parcel: 13245 SW Falcon Rise Dr. Pay Method: CreditCard Project Name: Johnson EXPLANATION: Per owner's request as job was cancelled. Refund 80% of permit fees. - -RE.FUND_ INFORMATION:.. • ' ` ,.. . ' • ,.. Revenu - Account No . '''.' Refund - Fee'De Receipt_ Examples;. (BUILD.] :Permit Fee • - Example: .245:0b00432000.,:.' ..::. • _ • $ Amount.. [BUILD] Bldg Permit 245 - 0000 - 432000 $315.20 [TAX] Bldg 12% State Surcharge 100- 0000 - 207020 37.83 [MECH] MEC Permit 245 - 0000 - 431010 58.00 [TAX] MEC 12% State Surcharge 100- 0000 - 207020 6.96 [PLUMB] PLM Permit 245- 0000 - 431000 58.00 [TAX] PLM 12% State Surcharge 100 - 0000 - 207020 6.96 (ELPRMT] ELC Permit 220 - 0000 - 431510 42.80 [TAXI ELC 12% State Surcharge 100- 0000 - 207020 5.14 TOTAL REFUND: $530.89 APPROVALS: If under $500 Professional Staff Al If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board :., FORTIDEMARK SYSTEM'ADMINISTRATION.USE ONI: Case Refund Processed: I Date: /007,P I By: l: \ Building \Refunds \RefundRequest.doc 05/23/07 • CITY OF rE'9(.\RD It)/2-1/3(1(►r; . 8:1 3:34,\ \'1 „ ' I i_aui II '173 :II III 4171 K. • Refund Receipt #: 27200800000000003671 , .6 - Date: 10 /24/2008 Lino Items: Case Nu Trail Code Description Revenue Account No Amount I'aid i\-IS -00I25 Reversal - [BUILD] RI& Permit 245- 0000 - 43200(1 (315.20) N IS (2001- 0(1125 Reversal - [TAN] Build 12% Sta 100 - 00(11)- 207020 (37.83) IST2001 -0()I25 Reversal - [iMLC'I -1] MEC Permit 245- 0000- 431(110 (58.00) iMST2001- 001 _ Reversal - [TAX] i\'IEC 12% State 100- 0000 - 207020 (6.96) MST2008 -00125 Reversal - [PLUMB] PLM Permit 245- 0000 - 431000 (58.00) MST3001- 0(125 Reversal - [TAX] PLM 12% State 100- 0000 - 207020 (6.96) MST2008- 0(125 Reversal - [1H1_I'RMT] ELC Permit 220-0000-431510 (42.80) MST2008 -00125 Reversal - [TAX] ELC 1 State 100 - 0000 - 207020 (5.14) Line Item Total: (S530.89) Refund: Method Paver User ID Acct. /Check No. Approval No. How Received Amount Paid Credit Reversal ! \IAT'I'lil \ \' IOI I:NSON 024720 In Person (530.89) Refund "I'ntal: ($5311.8'1) CITY OF TIGARD Io�l6�200 J 13125 SW Flail lilvd. 1:07:22PM • Tigard, OR 97223 503.639.4171 'IGARD Receipt #: 27200800000000003299 ()A /CWV/I Date: 09/19/2008 Line I tems: . Case No Tran Code Description Revenue Account No Amount Paid MST2008 -00 1 2 5 [BUILD] Bldg Permit 245 -0000 - 432000 394.00 MST2008- 00125 [TAX] Build 12% State Surchrge I00- 0000 - 207020 47.28 MST2008-00 125 [MECH] MEC Permit 245- 0000 - 431010 72.50 MST2008 -00 1 25 [TAX] MEC 12% State Surcharge 100 -0000- 207020 8.70 MST2008 -00125 [PLUMB] PLM Permit 245 -0000- 431000 72.50 MST2008 -00125 [TAX] PLM 12`%, State Surcharge 100- 0000 - 207020 8.70 MST2008 -00125 [ELPRMT] ELC Permit 220- 0000 - 431510 53.50 MST2008 -00125 [TAX] ELC 12% State Surcharge 100 -0000- 207020 6.42 Line Item Total: $663.60 Payments: \lethod Payer User ID Acct. /Check No. Approval No. H ow Received Amount Paid CreditCard \ : • M.: - 2 BTT 024729 In Person 663.60 _ , R I — - • NC. Payment Total: $663.60 1 3 I i1 I Building Division One & Two - Family Dwelling T I G A R D Fees Checklist PERMIT INFORMATION: . Permit #: ry) i - 2 CoS . OCR 1-2 5 Plan #: C T O Date: % • 2 7 .0 o Site Address: 132 Lis a k ?ca Q S Q r , Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: • Setbacks: Front: Rear: Left: Right: Class of Work: �` r Stories: First Floor: Type of Use: Height: Second Floor: Construction: Floor Load: 50 Third Floor: Occupancy Group: 3 Dwelling Units: I Total Floors: Valuation: ,) d0C) Bedrooms: Basement:: Beaverton CET: ,t` Bathrooms: Garage: Tig -Tual CET: ee5 - Decks: Other: TVFR: NIA Porches: Geo /Grading: .FEES: Description: Fee Amount: Amount Paid: Balance Due: Plan Check: Building: Z,cj( . 10 25(O. ) O QS Extra Set: Permit: Building: 44. 00 Tax: L-172 8 Metro CET: School CET: O Mechanical '72 . C-) O Tax: g- 7 0 Plumbing: 7 Z .SO Tax: 8 70 Electrical: 5S.5 0 Tax: L(2 Low Voltage: Tax: IX CDC: CDC Ping. Rev.: Pi CDC LRP Fee: SDC: Parks: TIF Res.: TIF MT: Erosion Permit: Erosion CWS: Erosion COT: . Water Quality: Water Quantity: SUB - TOTAL: Q.1Q,70 6 (lS (vO Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: I:\ Building\ Forms \ResPlanCheckrces.doc 01 /19/07 Page 1 PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment/systems) Description I Qty. I Fee(ea.) I - Total Description I Qty I Fee(ea.) I Total . New 1- & 2- family dwellings Heating/Cooling (includes 100 ft. for each utility connection) . Air conditioning or heat pump* I 14.00 SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) 14.00 SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) 17.90 SFR (3) bath 399.00 Gas heat pump 14.00 Each additional bath/kitchen 45.00 Duct work 2. 10.00 Rain Drain, single family dwelling 65.25 Hydronic hot water system ' 14.00 • Fire sprinkler - sq. ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric) .. Fire sprinkler - sq. ft. 7,200 and greater _ 309.00 (in wall, in -duct, suspended, etc.) 14.00 '1 • Site Utilities . Flue /vent (for any of above) 6.80 Catch basin /area drain 16.60 _Repair units 12.15 Drywell /leach line /trench drain 16.60 Other Fuel Appliances Footing drain - 1' 100' 55.00 Water heater 10.00 Footing drain - each additional 100' 46.40 Gas fireplace 10.00 • Manufactured home utilities 110.00 Flue vent (water heater /gas fireplace) 10.00 . Manholes 16.60 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Rain drain connector 16.60 Wood fireplace/insert 10.00 Sanitary sewer - 1' 100' 55.00 Chimney /liner /flue /vent 10.00 Sanitary sewer - each additional 100' 46.40 Other: 10.00 Storm sewer 1 100' 55.00 Environmental Exhaust& Ventilation _ Storm sewer - each additional 100' 46.40 Range hood7other kitchen equipment 10.00 Water service - 1 100' 55.00 Clothes dryer exhaust 10.00 Water service - each additional 100' 46.40 . • • . Fixture or Item • Single duct exhaust Absorption valve 16.60 • (bathrooms, toilet compartments, Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer 16.60 Other: 10.00 Fuel Piping Dishwasher 16.60 * *($5.40 for first 4, $1.00 each additional) Drinking fountain 16.60 Furnace, etc. ** Ejectors /sump 16.60 Gas heat pump ** - Expansion tank . 16.60 Wall /suspended /unit heater ** Fixture /sewer cap 16.60 Water heater ** Floor drain /floor sink/hub 16.60 Fireplace ** Garbage disposal 16.60 Range ** Hose bib 16.60 BBQ ** Ice maker 16.60 Clothes dryer (gas) . ** Interceptor /grease trap 16.60 Other: ** Primer 16.60 Total: Roof drain (commercial) 16.60 Mechanical Permit Fees Sink/basin/lavatory 16.60 Subtotal: $ Tub /shower /shower pan 16.60 Minimum Permit Fee $72.50 $ Urinal 16.60 Plan Review Fee (25% of Permit Fee) $ Water closet 16.60 State Surcharge (12% of Permit Fee) $ Water heater 16.60 TOTAL PERMIT FEE $ Other: Other: ELECTRICAL FEES new residential • . • Plumbing Permit Fees ( residential) Subtotal $ Description Qty. Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less 145.15 4 Plan Review (25% of Permit Fee) $ Ea. add'I 500 sq. ft. or portion 33.40 t • State Surcharge (12% of Permit Fee) $ Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling, service and /or feeder 90.90 2 Electrical Permit Fees . Subtotal: $ Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ TOTAL PERMIT FEE $ 1: \ Building \ Forms \ ResPlanCheckFees.doc 01/19/07 Page 2