Permit CITY OF TIGARD
MASTER PERMIT
:. s' COMMUNITY DEVELOPMENT �� Permit #: MST2013 00118
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 � 7Lt Date Issued: 06/11 /2013
Parcel: 2S110BA03200
Jurisdiction: Tigard
Site address: 11515 SW CLOUD CT
Subdivision: SHADOW HILLS Lot: 32
Project: Sorenson
Project Description: Master bathroom and bedroom remodel. 7/24/13, adding repair of 934 sw ft deck to scope of
work
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: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $55,270.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 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 & 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:
SORENSEN, CATHIE A OWNER Required Items and Reports (Conditions)
11515 SW CLOUD CT
TIGARD, OR 97224
PHONE: 503 - 939 -9164 PHONE:
FAX:
Total Fees: $2,042.40 .
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. . ' NTION: Ore• • law requires you to follow the rules adopted by the Oregon Utility — • Center. Those rules are set forth in OAR
952 -• • 1 -0010 through OAR 952-:11-009 u ma obtain a copy of the rules or direct questions to OUNC • -= ....•rte 232 or 1.800.332.2344.
Iss ed By: 1 ._ . �t� ) Permittee Signatur= 7, Q1-(c A■t ,
Call 503.639.4175 by 7:00 a.m. for the next available Inspection dat
This permit card shall be kept in a conspicuous place on the Job site until comp etion of the project.
Approved plans are required on the Job site at the time of each inspection.
•
FOR OFFICE USE ONLY — SITE ADDRESS:
This form is recognized by most building departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1 I Transmittal Letter
r i G nli n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: 717 10_ DATE REC
IVED
DEPT: BUILDING DIVISION
Jul.. 2 4 F^'3
FROM: $11111111bP ■' I� CITY OFTIGARD
BUILDING DIVISION
COMPANY:
PHONE:
B
RE: I _l c- f �/ 5 - 601/0
O
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain): (�
REMARKS: Cl_e_ed2—
6,6 FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
•
$ -0&q-
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
1:\Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012
•
•
�� CITY OF TIGARD MASTER PERMIT
a - COMMUNITY DEVELOPMENT Permit #: MST2013 00118
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2013
Parcel: 26 110BA03200
Jurisdiction: Tigard
Site address: 11515 SW CLOUD CT
Subdivision: SHADOW HILLS Lot: 32
Project: Sorenson
Project Description: Master bathroom and bedroom 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: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $36,300.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell -Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
• Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Tamp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea addl 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 +ampNolt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & 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:
SORENSEN, CATHIE A OWNER Required Items and Reports (Conditions)
11515 SW CLOUD CT
TIGARD, OR 97224
PHONE: 503- 939 -9164 PHONE:
FAX:
Total Fees: $1,373.51
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wo . is suspen• --d for more the 180
days. AT TION: • : , on la . equires you to follow the rules adopted by the Oregon Utility Notification C - . - r. a ru , s — set forth in OAR
952 -00 010 through OAR • - 001 -0090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503 : o;�33 1.44. ea 4111/
Issu d By: ! _ /i .d .1 -A Permittee Signature: / -I /�.� Aell
Call 503.639.4175 by 7:00 a.m. for the next available Inspection • . •:.
This permit card shall be kept in a conspicuous place on the Job site until completion of the : oject.
Approved plans are required on the job site at the time of each Inspection.
Building Permit Application
Residential RECEIVED 1:0 OFF USE ONLY
City of Tigard MAY 16 2013 Date Received ,S I (0 I/ 3 £f Permit No.USTo)0 !3 -00 /f
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review , \ r_ I�
' Phone: 503.718.2439 Fax: 503.598.196 Date/By: QJI �i p l l� der Permit:
I' I L. A It I7 Inspection Line: 503.639 L ITY OF TIGARD Date Ready
/By: Juns: ® See Page 2 for
BUI DIVISION to /s / t [ Y/ Supplemental Information
Internet: www.tigard Da Read Notified/Method: ��
VA/ (cJ /C4
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
dditior�ai eratio placem ❑ Other: equipment, materials, labor, overhead, and the profit for the
c CATEGORY OF CONSTRUCTION work indicated on this application.
1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ �j 00
nn ��,,
❑Accessory building ❑ Multi- family Number of bedrooms: i�!GO/lry4, eaf
❑ Master builder ❑ Other: Number of bathrooms: Pi 0 € V
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ft 71.6.- SW CLOiii k C'i ) New dwelling area: square feet
City/State /ZIP: i c / O2 / - 1 Z2 Garage /carport area: square feet
Suite/bldg./apt. no.: P roject name: 7000M parnoll a Covered porch area: square feet
Cross street/directions to job site: 13/41 614 r — o a L n ..� (,(4' Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ' 'l a 1S '. I Lot no.: '3 Permit fees' are based on the value of the work performed.
Tax map /parcel no.: 26140 DA - 0 3.WO ' 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.
M il e 44..— egittra aVeir i . &0 1 200.,,,,, 0 L Valuation: $
Existing building area square feet
New building area: square feet
(.PROPERTY OWNER ❑ TENANT Number of stories:
Name: G Type of construction:
Address: r + C' C 5 IA ) gr Occupancy groups:
City/State /ZIP: '11 fl_ ,O2 (l 7 z. Z4. Existing:
Phone: (.3) e 341 ' 9 i (4' C e I) Fax: (W3) leg - Wt -74, ()Ma) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: (ow NMI FLS plan review fee (if applicable):
Address:
City/State /ZIP: Total fees due upon application:
Phone: ( ) I Fax: : ( ) Amount received:
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two (2) sets of roof plan with connection details
/� , 1 and fire department access, along with the 2010 Oregon
Address: v I" Solar Installation Specialty Code checklist.
City /State /ZIP: Permit Fee (includes plan review $180.00
and administrative fees):
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature , / / This permit application expires if a permit is not obtained
A� , J / di within 180 days after it has been accepted as complete.
/ //3 * Fee methodology set by Tri -County Building Industry
. Print name: (
% Q d rein S I Date: is /6 Service Board.
I:\ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 46l3T(11/02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling E(.)R OFFICE USE ONLY
City of Tigard Received
i g Associated y: Permit No.:
q 13125 SW Hall Blvd., Tigard,OR 97223 ill Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard -or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR I'LAN REVIEW 1'es No N/.
1 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. ' ❑ ❑ ❑
l 7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑'plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state , ❑ 1 CI CI
building codes. Lateral design details and connections must be incorporated into the plans or on a'separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if _
copyright violations exist. .
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; .property corner elevations (if r ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show .contour lines, at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection, details, vent size ❑ ❑ ❑
and location. \ l I , / ' I
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ■ , , f ❑ ❑
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 ,1
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." I
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 CI 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 • El ❑ ❑
architect licensed in Ore_on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS•
23 Three (3) site plans are required f o r Item I I 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. F III ❑ ❑
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- 613T(11/02 /COM/WEB)
• '
• Electrical Permit Application I FOR OFFICE USE OiNLI
RECEIVE .
is Received {(/
City of Tigard � ' Permit No.: ASTo)Q(3 — �oll ,
° 13125 SW Hall Blvd., Tigard, OR 97223 MAY 16 2013 Plan Review
'� Date/By: V C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
I' I C. n It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING I /I V ISIoN Notified/Method: 11 ( Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction R 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
wl- 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 ",
nJ IOOHP or more. occupancy.
Job no.: Job site address: I 1 l 4Q LL d� ❑ Six or mare residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -�^'� /�� 2 2_ 4' ❑ Health-care facilities.
❑ Supply voltage for more than
1 ` 9 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: t n ❑ Service or feeder 600 amps or more.
� i .t'/ /^tiAL[ FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
2. �� r �1 I V , t , , t . , , - Includes attached garage.
Subdivision: 4 , ,I 1 1 S Lot no.: 5 Z 1,000 sq. ft. or less 168.54 4
�J�, Ea. add'I 500 sq. R. or portion 33.92 I
Tax map /parcel no.''61 `C 6A_ -- to 3 Z Co Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Q
� / / ° 1 V `f �� ` Limited energy, ith a o v e sq. 75.00 2 (7..... (7..... (,/( .� ' w .� / '��C_Y_11� � • '� residential (with above sq. ft.) _
Renewable Energy ❑ See Page 2
e t 4-i2A Services or feeders installation, alteration, and/or relocation
X PROPERTY OWNER I ❑ TENANT 200 amps or Tess 100.70 2
201 amps to 400 amps 133.56 2
Name: c1 J ¶ s/,'
+, /� 401 amps to 600 amps 200.34 2
Address: ` i ) 91 ` .5L ex p ni. 601 amps to 1,000 amps 301.04 2
A Over 1,000 amps or volts 552.26 2
City/State /ZIP: • - f _ („ 4) , "�2.A -- Temporary services or feeders installation, alteration, and/or
Phone: (, 3) � 1 g 11 34,/ - /b, A Fax: (5o30 281 - y'% ie) relocation
200 amps or less 59.36 I
Owner installation: Th' ins . I: io is . mg made on property that I own which ' not 201 amps to 400 amps 125.08 2
intended for sale, ,.,.?: 9e I . according to ORS 447, 449, 670, d 01.
' 401 amps to 599 amps 168.54 2
q Owner signatur : i! %I�� / . Date: I / I a Branch circuits - new, alteration, or extension, per panel
7 ❑ APPLI NT ❑ CONTACT PERS N A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: 0 ^ i� service or feeder fee, first l
" Z branch circuit 56.18 2
Address: Each add'I branch circuit Z 7.42 _ 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: ., Signal circuit(s) or limited- energy
/� r n J ( � � 1 l. � panel, alteration, or extension. Page 2 2
Address: v Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Phone: ( ) Fax: ( ) Industrial plant (I hr min) 78.18 / hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed (%r hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: / Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: AI� ` r TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: ea 7 1 4 a /1' "doe-kg-ell Date: 6-/A143 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1: \ Building\ Permits \ELC_PermitApp_040913.doc 440.4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
•
Limited Energy Permit Fees: Renewable Energy Permit Fees:
• 1 RESIDENTIAL WORK ONLY: - 1 FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
I
❑ Garage Door Opener* 1 50.01 to 100 kW 552.26 2
■ t 1 >100 kva (fee in accordance with -
•
1 OAR 918- 309 -0040) ' 552.26 2
❑ Heating, Ventilation and Air Conditioning I , - Solar ge systems in excess of 25 kva:
System*
Each additional kva over25 7.42 3
❑ Vacuum Systems* I I - >100 kva — no additional charge • , 0.0 , d 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional.inspection is 66.25/ hr 1
charged at an hourly (I hr min). • ■
Inspections for which no fee is 90.00/ hr
specifically listed (f. hr min)
COMMERCIAL WORK ONLY: .. . j ELECTRICAL PERMIT FEES
Fee for each commercial system $75:00 S ubtotal: % 1
(SEE OAR 918- 309 -0000) )Plan review, if required (25% of permit fee): '; ,
State surcharge (12% of permit fee): ,
Check Type of Work Involved: TOTAL PERMIT FEE:
' , 1 ' '''s ' This permit application expires if a permit ismot obtained within 180
❑ Audio and Stereo Systems ( days after it has been accepted as complete.
• Number of inspections allowed per permit I 1
❑ Boiler Controls 1 }
``
1 . 1 .,
❑ Clock Systems
•
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC I .
. I
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls i j
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations • . ,._
I:\BuildingTermits\ELC_PermitApp_040913.doc
Mechanical Permit ApplicatiREC IVE® FOR OFFICE USE ONI.Y
1N City of Tigard DateBy: 5 i/ (A Permit No.: r a t / ,
° 13125 SW Hall Blvd., Tigard,OR 97223 MAY 16 2013
• C Date/By: Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: runs: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction (Additi sig . rr� replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
ia 1- 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: (676-' / 6 cj (y 31- Air conditioning 46.75
Furnace 100,000 BTU ( ducts/vents) 46.75
City/State /ZIP: I akel (31,- V' 7 2 L t:. Fumace 100,000+ BTU (ducts/vents) 54.91
,� J ( t , a / Heat pump �^ 61.06
Suite/bldg. /apt. no.: Project name: 50 re in SLo h /r( r J ( Duct work v i 23.32
• Cross street/directions to job site: Hydronic hot water system 23.32
�f/� /�. /�/ Residential
/ "'C ���(LGN.� �C /�!!� 64. hydronic) boiler (radiator or 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
/ / eI 3 Z
Other: 23.32
Subdivision: 6 4 ( Lot no.: e7 Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Mad/ /�,�_ Flue vent for water heater or gas
eV /��a�I�a��Zi ea Si /64o 064./ fireplace 23.32
7 z s/ 445 6 A
et(d cat lb de A-. Log lighter (gas) 23.32
r
C / Wood/pellet stove 33.39
,20/0/ sl ili • li1os-o fael 7X 34 Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
f PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: (J)7t/ P Sore vt el Range hood/other kitchen
, ) equipment 33.39
Address: /( S7 6 ('/W (2(n' f t Clothes dryer exhaust 33.39
City/State/ZIP: 7 c9 72 z � Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) , 23.32
Phone: (5b3) q 97( ( / /) Fax: (S33) 281 - •GC- Attic/crawlspace fans 23.32
❑ APPLICANT 1 % ❑ CONTACT PERSON Other: _ 23.32
Fuel piping:
Business name: ( ' (.9 W /14.Ar) $14.15 for first four; $4.03 for each additional
Contact name: • Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas)
(17
Business name: 000PE (2- Other:
MECHANICAL PERMIT FEES*
Address: Subtotal
City /State /ZIP: Minimum permit fee ($90.00)
Plan review (25% of permit fee)
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee)
CCB lic.: TOTAL PERMIT FEE
(2 / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ''� • Fee methodology set by Tri -County Building Industry Service Board
Print name: . / e 4 • d re.Aceh I Date: /4 15
I:\Building\Pennits C_PermitApp 040113.doc 440 -4617r I /02/COM/WEB)
Mechanical Permit Application - City of Tigard r.
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and •
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100;000.00 $1,363.71 for the first $50,000:00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:Building\Permits MEC_PermitApp_040113.doc 2
Plumbing Permit Applicatio
Building Fixtures RECEIVED I:t)IZ OFFICE USE ONLY
City of Tigard MAY 16 2013 Received ,// yr
Permit No
0 13125 SW Hall Blvd., Tigard, OR 97223
Date/By: b 1 � d '� s ���3 - Ofl 1
1111 C Plan Review
Ph one: 503.718.2439 Fax: 503.598. F9(T/ OF TIGARD Date/By: Other Permit No.:
I l C. n F u Inspection Line: 503.639.4175 V � �' T' V Date Read Suns El See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/M 110 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction a Demolition For special information use check list
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
-,-
1$.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 ❑ Other: Fire sprinkler ( sq. ft.) Page 2
' JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: , j 5- do,,, 4. ( Catch basin or area drain 18.76
1, leach line, or trench drain
City /State /ZIP: Y7 N'v 2 9 i 2 7 �A � Page 2
l V t n Footing Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 249�se r Peo
• vni � L Manufactured home utilities 50.03
Cross street/directions to job site: l Q F-C �c Manholes 18.76
,1� ' _ w ----> /�� F r ii �� 1, Rain drain connector 18.76
1 I I S1 Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: ZS 1 J 0 t
A - 03 ZOO Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer ' 25.02
1 - =.D. / t.a T ..I _ - Dishwasher 25.02 �
2/1-Le Al .. - • 648- E) 4i/1i k-,$ Drinking fountain 25.02
■ FAA ,a “4 01.,a er- A ity IL 44 pcigin y a, Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: / �j Fixture /sewer cap 25.02
C_h11111 €� ` O�� ' Floor drain/floor sink/hub 25.02
Address: 5.1 W n Cfr
5 `�Ll- y� Garbage disposal 25.02
City /State /ZIP: 11 hOpaz 0 (/J, L2 4- Hose bib 25.02
Phone: (J q q . � l 4, Cell) Fax: (B03) 2,8q - (�i7iy.IL�IQ� Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSO Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: 01 id 's ",e C- Sink/basin/lavatory i 0/7.- - S - 25.02
City /State /ZIP: Solar units (potable water 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51
E -mail: Urinal 25.02
Water closet 1 25.02
CONTRACTOR
_ Water heater 37.52
• Business name: T +v ,S Om A, 61 ( _ Water piping/DW V 56.29
Address: 'C e /e&t A VI - Other: 25.02
City /State /ZIP: Q�yf 0 7/ Subtotal
/ Pho. -: (503) lG _� � 1
Fax:
� ( 1 ) Minimum permit fee: $72.50
' CB Lic.: - I ; '2 d Plumbi • Lic. no.: g -99/ 1,. Plan review (25 % of permit fee)
State surcharge (12% of permit fee)
Authorized signature: �� TOTAL PERMIT FEE
Print name: Cr - e ' . D ren s e y I Date: s //(�//3 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.
1 :\ Building \Pennits\PLMU- PermitApp.doc 10/01/09 440-4616T(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' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee: _ ,
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 •
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.: !
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 ' $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) - each additional $100.00 or, fraction thereof, to
Reinspection Fees 90.00/hr _ and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
. i I 1 V •
Commercial Fixture Work: ‘ ; . ) . ; , '
Are you capping, adding or replacing fixtures? If "yes ", 1 , ,
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 is required for any of the following. ` i i
Fixture Type for Replace/ 1Please check,all that apply: ,
Work Performed: Capped Added Relocate '
❑ Any new commercial building with water service 2" and
Baptistry/Font I ' ' t 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 tall 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
Garbage - Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice MachARefrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang •1
-Stall
Sink: -LavBar non -food related '
- Bradley
- Com/Serv/Util food related .
- Service *Note: If the fixture work under th permit results in an
Swimming Pool Filter • increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal .
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Property Owner Statement
Regarding Construction Responsibilities
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 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
ie
Sore
kt sCe
Print N e of pe it Applicant
A( /3
Si ature of P it Applicant Date
H - r a o �3 - C(/ '
Permit #:
Address: / 1 S/ 5 5'1-0 CLoub C% . .
Issued b Date: 0/ // '2) 1:
This Copy for Permit Offices