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Permit 1 E Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phonc: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ® Applicant ❑ Contractor g- City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) T.SM 64 Q 92 e77 FGTS LLB MA/LK S IrA M,^/ Mailing Address: l6 `10 ? S t ! 5 A.4 City/State /Zip: ?viz n LA& I cm _ q7)-11 Phone No.: (03) a - iSSSO PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL PERMIT APPLICATION. • 'a_ - _ . 11 P IT FEES (attach receipt, if available). 01 INVOIC - OR FEES DUE (attach case fee schedule and explain below). IN ' MOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: Mg - r - ? w7 — 00 1 31 Site Address or Parcel #: q '3'a'a S W N O 1 DA kc rA Project Name: P 6 - t 4- G 4 !PAA- x u.A./ - 'T. -u.,✓ Subdivision Name: SqM,f__ Lot #: f EXPLANATION: uk.m t, A 5 AA, o c A, r. o Alsm-s- i) 6 >.. xf•, � , -. , ,T.S,,.✓ 1 A,i j� - - � N./ 6 l e) A . � v, a . *7/D', 'L �xc� Signature: 01 A) c,-. L) ..,,,`k - Date: /0 -- j 7_ Og. Print Name: / A A n k ' J A< t OM 4. L 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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. e) 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 Sys Admin: Date By Rte to Bldg Admin: Date /0 Z% Of By . •' Refund Processed: Date By Invoice Processed: Date /274f' By i •i. Permit Canceled: Date By Parcel Tag Added: Date _ By Receipt # Date Method Amount $ I: \Building \ Forms \Regl'ermitAction.doc Rev 07/26/07 a / °C)\ CITY OF TIGARD Building Division TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503 -639 -4171 INVOICE TO: Timber Projects LLC Customer ID: 164939 8407 SW 58 Invoice No.: INV2008 -00020 Portland, OR 97219 Invoice Date: 10/24/08 Attn: Mark Seaman Date Due: Upon Receipt Case No. :. Site Address Subdivision - Lot # or Project Name Amount Due MST2007 -00134 9322 SW North Dakota St. Hellwege Partition $110.02 MST2007 -00133 9254 SW North Dakota St. Hellwege Partition $110.02 Invoice Total: $220.04 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2007- 00134/MST2007 -00133 Customer ID: 164939 Site Address: Various Invoice No.: INV2008 -00020 Project: Hellwege Parition, Lots 1 & 2 Invoice Date: 10/24/08 Date Due: Upon Receipt Invoice Total: $220.04 Amount Paid: $ Office Note: Please forward copy of receipt to Dianna Howse. Please mail payment to: City of Tigard, Building Division 13125 SW Hall Blvd. Tigard, OR 97223 Attn: Dianna Howse I: \Bull ding \Accounting \Invoice.doc 04/06 CITY OF TIGARD 10/21/2008 Fees Associated With 7:26:11AM • • . 13125 SW Hall Blvd. TIGARD Tigard, OR 97223 503.639.4171 Case #: MST2007 -00134 y 302, a 5 Ac1 Ai e/2171 %. 19 7 Z. C TT / Fee ' Start End . 4�' - >. Revenue . ,. Created - ' Type - 'Date "• Date Dept -Description . ': B Date .Amount Due Account lYumber Y BPLC 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Deposit 245- 0000 - 433000 BLD 7/18/2007 750.00 0.00 CDCP 1/1/1990 12/31/2020 [CDCPLN] CDC Pln Rev 100 - 0000 - 433060 MAV 8/13/2007 46.00 46.00 ✓ LRPI 12/28/2004 12/31/2020 [LRPF] LR Planning Surcharge 100- 0000 - 438050 MAV 8/13/2007 6.00 6.00 ✓ BPLD 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Balance 245- 0000 - 433000 MAV 8/13/2007 16.42 16.42 ✓ BPRT 1/1/1990 12/31/2020 [BUILD] Bldg Permit 245- 0000 - 432000 MAV 8/13/2007 1,179.11 1,179.11 B5PC 1/1/1990 12/31/2020 [TAX] Build 8% State Surchrg 100 - 0000 - 207020 MAV 8/13/2007 94.33 94.33 MCET 7/1/2006 12/31/2020 [METCET] Metro Const Excise Tx 245- 0000 - 229202 MAV 8/13/2007 223.86 223.86 MPRT 1/1/1990 12/31/2020 [MECH] MEC Permit 245- 0000 - 431010 MAV 8/13/2007 83.70 83.70 M5 PC 1/1/1990 12/31/2020 [TAX] MEC 8% State Surcharge 100- 0000 - 207020 MAV 8/13/2007 6.70 6.70 PL3B 1/1/1990 12/31/2020 [PLUMB] PLM Prmt 3Bth 245- 0000 - 431000 MAV 8/13/2007 399.00 399.00 P5PC 1/1/1990 12/31/2020 [TAX] PLM 8% State Surcharge 100- 0000 - 207020 MAV 8/13/2007 31.92 31.92 ELCF 1/1/1990 12/31/2020 [ELPRMT] ELC Permit 220-0000-431510 MAV 8/13/2007 245.35 245.35 ELC5 1/1/1990 12/31/2020 [TAX] ELC 8% State Surcharge 100- 0000 - 207020 MAV 8/13/2007 19.63 19.63 ELRP 1/1/1990 12/31/2020 [ELPRMT] ELR Permit 220-0000-431510 MAV 8/13/2007 75.00 75.00 ELR5 1/1/1990 12/31/2020 [TAX] ELR 8% State Surcharge 100- 0000 - 207020 MAV 8/13/2007 6.00 6.00 TIFM 7/1/2002 12/31/2020 [TIF -MT] TIE Mass Tr 210 - 0000 - 448005 MAV 8/13/2007 240.00 240.00 EROS 1/1/1990 12/31/2020 [ ELPRMT] Erosion Control 100- 0000 - 207307 MAV 8/13/2007 64.00 64.00 ERPU 1/1/1990 12/31/2020 [ERPLN] Erosn Pln Rv CWS 100- 0000 - 207308 MAV 8/13/2007 20.80 20.80 `'..- ERPC 1/1/1990 12/31/2020 [EROSN] Erosn Pln Rv COT 245- 0000 - 433010 MAV 8/13/2007 20.80 20.80 .- WQUL 7/1/2001 12/31/2020 [WQUAL] Water Quality 520- 0000 - 445002 MAV 8/13/2007 225.00 225.00 WQAT 7/1/2001 12/31/2020 [WQUANT] Water Quantity 520- 0000 - 445001 MAV 8/13/2007 275.00 275.00 PRK6 7/1/2005 12/31/2020 [PKSDC] SF Park SDC 270 - 0000 - 450000 MAV 8/13/2007 4,812.00 4,812.00 TIFR 7/1/2002 12/31/2020 [TIF -R] TLF Resident 210- 0000 - 448001 BLD 6/5/2008 2,960.00 2,960.00 Total Due: $11,050.62 Page 1 of 1 CaseFees..rpt A fro V£ b 5 r Lia5rz xf D )V1 F Perk_ C C,N J 5 , 4 . - w Arta 6a �u 4. �- -'' `') Rk. �7uJ „Ac Building Permit Application C>` / /O /i7 /p er ' Residential �, �� FOR OFFICE USE ONLY fi--z • \• R eceived City of Tigard . Date�By. ' 7 �g o7 Date 71 ,X PermitNo.li 7 - ' .. � /3 13125 SW Hall Blvd., Ti 223 Q Plan Review y: C Phone: 503.639.4171 Fax: 503.598900 1. 2 007 B /1/1 Other Permit: c laN24,07,e6 I ga T I G A R D Inspection Line: 503.639 �� Date Ready /By: lype ® See Page 2 for Internet: www.ligard- or.gov CrlY ; o 9 - ' � Notified/Method: l� la Supplemental Information rktr e� /31 TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING c g,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. [71- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: LA ❑Master builder ❑Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: Clk z'z S ..L1u , N cT A _ I kr6 -v- uCt, New dwelling area: (-1 ,(A \ square feet City /State /ZIP: ''V -v-a. V+-,4 C45- Garage /carport area: L-4 8 0 square feet Suite/bldg. /apt. no.: Project name: Covered porch area: ' square feet I C\22 • e:1- . p tip V'. �f'V R Deck area: square feet Cross street/directions to job site: 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. L Cjv Si d. -� c--r 1. v.) 0 f t €1...A..1 S n v'J ti-Lt— Valuation: $ Existing building area: square feet .aAw ∎ L i1 v- New building area: square feet IPROPERTY OWNER ❑ TENANT Number of stories: Name: M .f da...VC. cF trA. rd■ IA e■-.) Type of construction: Address: 'a l 6 - . �� ( J . Occupancy groups: City /State /ZIP: 'V.1- ` , 4 r) vs...Q_ C Z \ Existing: Phone: (WI) Z. b cksfyzek Fax: (Sod 2_,t..k.' 2 (yri New: ,21PPLICANT 2 PERSON NOTICE Business name: •-( ,. .,,.. C,, r..,cz. \ l__. L..C--- All contractors and subcontractors are required to be Contact name: M ,e�� S �, r licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the R Address: t� L 01 S ; `iJ � , S T jurisdiction in which work is being performed. If the City/State /ZIP: e-� - O ��- S'i Z� applicant is exempt from licensing, the following reasons q� apply: Phone: (5 �'S Z`..k ( Ct O Ci 0 I Fax:: (, Z4 `J c, 5 cs-1 E -mail: l--. EA. w % Av.) t- .. ■1 1-T V*1 G - T . C t-\ CONTRACTOR Business name: "�� w 7., s n t/..11 %fit - t . L.L L, BUILDING PERMIT FEES* Address: StR wl6 c sArs � (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax:( ) CCB lic.: \ �Q LAC-V I� Total fees due upon application: Amount received: Authorized signature: ,.tom This permit application expires if a permit is not obtained ` within 180 days after it has been accepted as complete. Print name:V�-lc S C_6fi'vh cArd Date: \ �J to "I • Fee methodology set by Tri- County Building Industry Service Board. 1:\Building\Permits \BUP -RES PermitApp.doc 02/23/07 440- 46I3T(I 1/02 /COM/WEB) ) \ Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: Ass v 13125 SW Hall Blvd., Tigard, OR 97223 oc at C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical TI GA RD 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. G ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 12' 0 ❑ 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- ❑ ❑ ❑ • protection, etc. 10 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ b I ng 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 , opyr ht violations exist. 1 Site/ of plan drawn to sca le. The plan must show lot and building setback dimensions; property corner elevations (if IX ❑ ❑ e 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 2r ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, f r ❑ ❑ 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. 12' ❑ ❑ 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 ❑ ❑ 1 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. EY ❑ a 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 tans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or I I" x 17 ". ❑ ❑ ❑ 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 \Permits\BUP- RES- PermitApp.doc 03/21/06 470- 4613T(II /02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY III r,t-• ice`1a ir ray l- /3 d Received City of Tigard :i ; 7 °� Permit No o j _ Date/By: SW Hall Blvd., Tigard, OR 9 2 3 Phone: 503.639.4171 Fax: 503.598.19M L 1 D a e Review �` , Plan Re Date/By: Other Permit: TI G A It D Inspection Line: 503.639 _ Date Ready /By: Juris El See Page 2 for Internet: www.tigard -or.gov � I y tr^ u b Notified/Method: Supplemental Information f�o�j l p t9qq� CM t ,'..-.14.:11.) /p 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* Z- 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: e 3 Z -L S �� N � �� fi �� T Air conditioning fires p or showing pump ) (requires site Ian showin placement) 14.00 City/State/ZIP: %_ 1/• Fumace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) t 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work t 10.00 c W �A Hydronic hot water system 14.00 \. -- 4- \L. dtt- vc 0 c Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: 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 l 10.00 Gas fireplace i 10.00 I-2.2 � `.)-S S ..N.) L w. Ems ♦ ``; Flue vent for water heater or gas -, fireplace I 10.00 • • - Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 • PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: v*.> V rk.e S C **"A" rsi Environmental exhaust and ventilation 4, t , A S w �'eC Range hood/other kitchen Address: ' N t equipment 4 10.00 City /State /ZIP: .. t. v 0-Z` 2 `Ct Clothes dryer exhaust 4 10.00 Single -duct exhaust (bathrooms, - Phone: ( z9sxj Z 4 6 C.( Bet 0 Fax: ( Z4 S g il l '- ell toilet compartments, utility rooms) 3 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 k Fireplace Q E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: d..,. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Plot A S eu4m.i‘.) Date: 7 i t o 1 Q • Fee methodology set by Tri- County Building Industry Service Board I :\ Building\Permits\MEC- PermitApp.doc 01/19/07 440-4617T (I t /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental 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. I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2 • Plumbing Permit Applic � en�, .. p,--[ ,, J1 r: Building Fixtures '�= `-A `' J FOR OFFICE USE ONLY City of Tigard JUL 1 8 2007 Received permit No I r�Or �7' QO/ Date /By: « tel IIIII a 13125 SW Hall Blvd., Tigard, Ori - 0 • Phone: 503.639.4171 Fax: 503.598..496 s I. D Plan Review Other Permit No.: Inspection Line: 503.639.4175 Date/By: P ��9 �1o�v ��(�� ®� Date Read /B ru ns: ® S ee Page 2 for Internet: www.ti T I G A It D ardor. ov y B g g Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For 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 ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El 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: Ck - 3 2_ - 1_. S . W • • f) vtlk vo.. i 1 Catch basin or area drain 16.60 City /State /ZIP: • T\ ��n d 0•.S2__ Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: 4 4 0) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: w Manholes 16.60 Z "'- .\-- „ U44■ V L `v - Rain drain connector 16.60 Sanitary sewer (no. line 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 v ,.S S „�/ Lam ,. 6 .. , Backwater valve 16.60 Clothes washer 4 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: r.• A Y , ./t A. S C " tn.I Expansion tank Address: eF L D'Z S ...) , '' Fixture /sewer cap 16.60 City /State /ZIP: P.-.r- Y.. uO C 0L4E_ 1 2 \ C & Floor drain/floor sink/hub 16.60 Phone: (.51: ).„ t o C i , 8Ck 0 Fax: ( 5 ) 'Zl... . a S Opt 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: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 Address: Other: Subtotal City /State /ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: et. .� State surcharge (8% of permit fee) • TOTAL PERMIT FEE Print name: r.A,A � ^ v 0 r / Date: 1 I vg I v `` 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 - 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 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 $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 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 fixtures 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. - 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: u:\ Building \Permils\PLM- PermitApp.doc 12/27/06 Electrical Permit Application FOR OFFICE USE ONLY Cl of Tigard ,( ice` i -.. Rece City _ /{ _ ,� {1 /I C e rmit No.: r,�/�� q �J g 1 - -, , I .Date/By: 7 � a 6'7 P /t O'1�7�t�� 13125 SW Hall Blvd., Tigard, OR 97223 I (_ 7 � !u I ;Plan Review '' C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI G A IL I� Inspection Line: 503.639.4175 JUL ll 8 ( i , / Date Ready /By: Juris: El See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information CM!: • . . TYPE OF W J C. •'. es PLAN REVIEW v tIt,/1 1 Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction ❑ Addition/alteration/replacement ❑ 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 ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: i 3 S .W , lv ., 0%f1� S (N Six or more a res. Recreational ❑ Six or more residential units. ❑Ron vehicle parks. City/State /ZIP: - -_— ❑ Health-care facilities. ❑ Supply voltage for more than : ;— A....P*4 ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: G Ns ._ .. AI& Q T. tA 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 i 145.15 4 Ea. add'I 500 sq. ft. or portion (. 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family / 75 2 t—� N�7t� I-- E— l •—• %,— residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation • 200 amps or less c 80.30 2 ,...aROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: A A- (4... s �� tN 401 amps to 600 amps 160.60 2 Q � T -- t� 0 " 601 amps to 1,000 amps 240.60 2 .... Address: q Z S , L , .c V Over 1,000 amps or volts 454.65 2 City/State /ZIP: 1 --' G...to c €-_ (\ "12.,\ Temporary services or feeders installation, alteration, and/or relocation Phone: Fax: ( 603 )zi{ (o 9 �4 O (5►Z) a C. E S T.) & 0.1 200 amps or less 4r 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, and 701. 401 amps to 599 amps 133.75 2 Branch circuits– new, alteration , or ex tension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 • each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l 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: 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 Lie.: Electrical Lie.: Suprv. Lie.: 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: A S cz I i fl ) This permit application a f expires if a permit is not obtained within 180 Print name: tA I en ,4 Date: 1 days after r been has been accepted as complete. • Number of inspections allowed per permit. 1:\Building\Permits\ELC- PermitApp.doc 05/23/06 440.4615T(11/05 /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 OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems • E l Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems • ❑ Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations • I:\ Building \Permits\ELC- PermitApp.doc 03/23/06 a BuiCding Permit Application Residential . .. FOR OFFICE USE ONLY 1114 City of Tigard Received 1y ® i . �JL .!�� y _ /,� # Date/By: f l D 0 / � - ( permit No7 L i/ de6 7 -C.l' 3Q C . Phone: 503.639.4171 Fax: 503.598 SW Hall Blvd., Tigard, OR 97223 c.r'; Plan Review C 47 �a 1960 _ Date/By: Permit: r TI G n K D Inspection Line: 503.639 Date Ready/By: Ju ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: it. Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING c&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. 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: !.-i ❑ Master builder ❑ Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: GL' a Z S ,:.N , N z9. \ ` �„ Aj , -- I A New dwelling area: k 1 W 1\ square feet City/State/ZIP: i ti.. V+-.4 C: .-z : Garage/carport area: Li D C; square feet Suite/bldg. /apt. no.: Project name: Covered porch area: ' square feet Cross street/directions to job site: ' - . (a.. , e iic. V Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: B 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. Valuation: $ C_ 6y..) 5 n ti -.a9 r- ..T cr tn1 G J 'S Az1'Li -•L15..._ 1—' ,. le--k `,,� Existing building area: square feet New building area: square feet (PROPERTY OWNER I ❑ TENANT . Number of stories: Name: "A j,. 5- F tra. +.A. IA Type of construction: Address: ��., Li 01 c . .,.,,j . Cam- ( t Occupancy groups: City/State /ZIP: Vcr `,a (c■ 0„.� C.-VA Z \` 4 Existing: Phone: (5'-z) z_, :A , i , ( 1.%" l Fax: (Sa 2,Lk% cl ea yi New: ,,APPLICANT a CONTACT PERSON . NOTICE Business name: "("a ,.zz,s_"_ tP� sx.zt- ` L...l._.C— All contractors and subcontractors are required to be Contact name: M A.44,01., S a." J'1:A s d licensed with the Oregon Construction Contractors Board PS under ORS 701 and may be required to be licensed in the Address: cS 41, ( A S - `.l-r • S t117-r-6 jurisdiction in which work is being performed. If the City/State /ZIP: �,� applicant is exempt from licensing, the following reasons � r' - y1 2_, app Phone: (56 2)4 W 9, a n t1 I Fax: : ( ) 2.4 tz 5 esi E -mail: 1.... S Edo v" .Atr.1 ti C2 d tbn in/ >zT ■ CN` CONTRACTOR Business name: -.. ZZurL t.4.4 E L_1.. BUILDING PERMIT FEES* Address: 5,......--k i p ( 1 re- (Please reel to fee scheduL) Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable): r, � � Total fees due upon application: CCB lic.: _ Amount received: Authorized signature: ,.sue This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Print name: R`iN� 'S y ;a q „ t AA Date: fl \ a ' Fee methodology set by Tri -County Building Industry ` Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 02/23/07 440- 4613T(11/02 /COM/WEB) RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: MST2007 -00134 Site Address: 9322 SW North Dakota Subdivision: Lot No.: Contact Name: Mark Seaman Business: Timber Projects LLC Street: 8407 SW 58th Ave. City: Portland State: OR Zip: 97219 As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or "complex" as defined in ORS 455.467 and 455.469. ® The application is complete. ❑ The application is incomplete for the following reason: ❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. ❑ The submitted plans cannot be reviewed until the above information has been submitted and /or approved. ❑ The plans are deemed "simple ". ® The plans are deemed "complex ". 7/19/07 Loraine Williams Date Plans Examiner 503.718.2708 loraine @tigard - or.gov I:\ Building\ Forms \RES- PermicAppRevw -LW -P.doc 1/18/07