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Permit CITY OF TIGARD MASTER PERMIT 1111 13 COMMUN DEVELOPMENT Permit #: MST2013 00132 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2013 Parcel: 2S104AC14400 Jurisdiction: Tigard Site address: 12990 SW HILLSIDE TER Subdivision: HILLSIDE ESTATES Lot: 9 Project: Hong Project Description: Create habitable space out of 1,334 square feet of existing crawl space. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 1334 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1334 sf Value: $142,844.72 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers' 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers. 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 6 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: v BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 1334 Owner: Contractor: HONG, LIEN Al LEDGEWOOD CONSTRUCTION LLC Required Items and Reports (Conditions) CHANCHALEUNE, SENGPRASITH PO BOX 298 12990 SW HILLSIDE TER SHERWOOD, OR 97140 TIGARD, OR 97223 PHONE: PHONE: 503- 522 -2500 FAX: Total Fees: $4,557.42 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 - -- - - ce 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. A ENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 0010 through •AR : 2 -0r 1 -0r 0. You may o•tain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued c • • _ _ / / I�/ Permittee Signature: 4 .-:__,__— --.__________ Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. 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. Builtlia Permit A licatio EcovED Residential FOR OFFICE USE ONLY . Received City of Tigard JUN 10 2 013 Date/By: (a /Q / 9 Permit No.: f z Q_, /- 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi .' s !s v 7 L i. i llii 0 Phone: 503.718.2439 Fax: 503.598.1 OF TIGARD Date/By: I `f 1 �'� Sher Permit: I' I C. A It D Inspection Line: 503.639 ' I /� Date ReadyBy: / �j ]iri ® See Page 2 for Internet: www.tigard-or.gov BUILDINM' G DoIVISIO No ethod: /� /'� ` '� Supplemental Information fin TYPE OF WORK • REQUIRED DATA: 1- AND 2- FAMILY DWELLING • ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 4ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application �q,, / pr 1- and 2 -famil dwelling Valuation: �( / y g ❑ Commercial/industrial ` / / El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: / JOB SITE INFORMATION AND LOCATION Total number of floors: 2 , / Job site address: / 95,e2 sa..) /�/sk-,:e 77--, ' rc -- _ New dwelling area: /?W' square feet City /State /ZIP: 72�y ®,� �/P r9" -Ze' Garage /carport area: square feet Suite/bldg. /apt. no.: ✓ Project name: Ar ©/J Covered porch area -69— square feet Cross street/directions to job site: df. #/W jjZ _ Deck area: _45:1._ square feet Other structure area: _._ square feet REQUIRED DATA: COMMERCIAL- USE CHECKLIST Subdivision: M. / 'i ® ..e 45: - 1 671.y I Lot no.: 4 9 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. i Ali • / Valuation: $ Existing building area square feet New building area: square feet 0 PROPERTY OWNER ❑ TENANT Number of stories: Name: ".•4 ._ /Wry Type of construction: Address: S Alc< Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ' *APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) ' ' Business name: Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable): Address: City /State /ZIP: Total fees due upon application: Phone: ( ) Fax :: ( ) Amount received: i j , E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM , FEES* Commercial and residential prescriptive installation of CONTRACTOR - roof -top mounted PhotoVoltaic Solar Panel System. Business name: `w� ` � e el & f � r sG jc -��,� ezc Submit two (2) sets of roof plan with connection details and fire dep. ent access, along with the 2010 Oregon Address: 0 X f ' Solar Installat : Specialty Cod - . - cklist. City /State /ZIP: U Permit Fee dud- an review ��'� o � � � 7 ® and . $180.00 Phone: (3} �� 2so0 Fax: ( State su • . ge (12 %o •errnit fee): $21.60 CCB lic.: ilelAri g 3 / //Y otal fee due upon appfica ' , I : $201.60 Authorized signature:!, This permit application expires if a perm ' not obtained within 180 days after it has been accepted as complete. Print name: Date: /v /�3 * Fee methodology set by Tri- County Building Industry C��/'�6 6j / Service Board I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 613T(I I /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Ti and Received lig g Date/By: No.: V 13125 SW Hall Blvd., Tigard,OR 97223 Associated permits: C • Phone: 503.718.2439 Fax: 503.598.1960 f l G A It p 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: TI -IE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 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. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. • ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore. on and shall be shown to be a, •licable to the •ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02 /COM/WEB) • Plumbing Permit Application Building Fixtures RECE F0R orh,Cl USE ONLY City of Tigard R eceived �/ 67)2-6 P ermit No.: D n 13125 SW Hall Blvd., Tigard, OR 972�f\ y Date/By: (.44//07/ /ylTaD� J L3� C Phone: 503.718.2439 Fax: 503.598 d ® 2013 Plan Review Date/By: Other Permit No.: Inspection Line: 503.639.4175 I'IGAKD Ready /By: CITY OF TIGARD Date Read B Ju ris: RI See Page 2 for Internet: www.tigard- or.gov NA DING 'r Notified/Method: Supplemental Information ' ' TYPE OF NADING DIVISIO IV 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 312.70 %I- 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: /I( .9/ e/ .5",,, .5",,, MV/ /7",,,,/.....0e7._(.. Catch basin or area drain 18.76 City /State /ZIP: �9 e/' 9.22.' F otin d ai nh line, or trench drain a 2 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: i e- Manufactured home utilities 50.03 Cross street/ directions to job site: Manholes 18.76 /4. 74,e5/XA Rain drain connector 18.76 / Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: A `),./ I Lot no.: _ Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 . 0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: ,4 f <A f � 197.e., Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: c 1� c Garbage disposal 25.02 - City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 • ' ' • ❑ - APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory ( A.7 1, I .7 , 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan r 12.51 E -mail: Urinal 25.02 Water closet 1 25.02 'CONTRACTOR '' ' 1 Water heater 37.52 Business name: jcl©rf�S r p'( w b in_s I tJ' Water piping/DWV i 56.29 Address: awe) 6u.; C he P ri A n iZe l Other: 25.02 City /State /ZIP: she rw0oct t o(Z °tl 1,1 0 Subtotal Phone: (5b3 0 ' ,- - � Fax: (66- s'- 1/5' 7 Minimum permit fee: $72.50 CCB Lie.: ( f "f ( c€ Plumbing Lic. no� 4j5 Plan review (25% of permit fee) l State surcharge (12% of permit fee) Authorized signature: _ CiiiM 7/i f • TOTAL PERMIT FEE Print name: ` 3 k (Y\ /� : a S `� / ,.,- > ,^ I Dates/ J 13 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:\ BuildingWermits \PLMU- PermitApp.doc 10/01/09 440- 46I6T(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 90.00/1u and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: -Tub/Shower engineer. - Jacuzzi/Whirlpool 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 Mach./Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: - Lav/Bar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor WaterCloset - Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2 A. Mechanical Permit A 1 flit ` ,, E !F D FOR OFFICE USE ONLY `J g City of Tigard Received Date/By: tf'/ E mmitioram illiM Permit No.: /� 0/✓ ✓ Q��O 2 1114 . c /� ° 13125 SW Hall Blvd., Tigard, 977n1 10 20 Plan Review Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit: T I G A R D Inspection Line: 503.639 CITY ARD OF TIG Date Ready/By: kris: ® See Page 2 for Internet: www.tigard - or.gov V I 1 fl Notified/Method: Supplemental Information BUILDING DIVISlow TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work • ❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 'Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* N I 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: /,79 ? $ 2 /�j _/ Air conditioning ace 1 io 100,000 46 Job site address: lam-( 7 .?„,,,,,..._, Furnace 100,000 BTU ( ducts/vents) / 46.75 City/State /ZIP: 7 Q 0" 4e9r, 97ZZ 7 Furnace 100,000+ BTU (ducts/vents) 54.91 Heat pump 61.06 Suite/bldg. /apt. no.: Project name: Duct work / 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 � h ys i ) boiler (radiator or �` h droniconic 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: ,(f Lot no.: Other: 23.32 /' / �G Other fuel appliances: Tax map /parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney/liner /flue /vent 23.32 ❑ PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: iif.,� -t r✓ Range hood/other kitchen Address: � i� ce II equipment 33.39 Clothes dryer exhaust 33.39 City/State /ZIP: Single -duct exhaust (bathrooms, toilet compartments, utility rooms) / 23.32 Phone: ( ) Fax: ( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four; $4.03 for each additional Contact name: Furnace, etc. Address: Gas heat pump WalUsuspended/unit heater City/State /ZIP: Water heater Phone: ( ) Fax: : ( ) Fireplace Range E -mail: Barbecue CONTRACTOR Clothes dryer (gas) Business name: r(�, Ge K� ran �� a 1 r [ Other: IN MECHANICAL PERMIT FEES* , Address: ' (,-,. (o erc Y"S, 1L Subtotal City/State /ZIP: ©`C OA 1�1\ f^, J c ) j Ql ' O y S.- Minimum permit fee ($90.00) Phone: r r 0 j) � Fax: II ` / Plan review (25% of permit fee) `� -7 b ok, I (W3 ) (0 3 - 7 b Y 6 State surcharge (12% of permit fee) CCB lie.: L1 iisbtl (e/51/ S TOTAL PERMIT FEE _ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: Q h • Fee methodology set by Tri- County Building Industry Service Board Print name: 9 LA of L S4. aA (, ,` Date: S f/o I:\ Building\ Permits \MEC_PennitApp_040113.doc 440 -461 (I1 /02/COM/WEB) • Mechanical Permit Application City of Tigard Page 2 - Supplemen'tal 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 foreach additional $100.00 or fraction thereof, to and including $5,000.00. { $5,000.01 to $10,000.00 $20721 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 and • ' $2.54 for each additional $100A0 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 foreach 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. • • n • • '( ' I Y I: Building\Permits\MEC_PermitApp 040113.doc 2 • Electrical Permit Applic . jw1( 'l ` 4 FOR OFFICE' USE ONLY g City of Tigard � 2 Received / / �n,� `.7 ����A� Date/By: CQ /' /,T l Permit No.: �!J'/r'7LJ/ - / ��- ° 13125 SW Hall Blvd., Tigard,OR OA 1 0 2013 Plan Review C • Phone: 503.718.2439 Fax: 50 598.1960 Date/By: Other Permit: T I G A l: D Inspection Line: 503.639.4175 L Date/By: Date Ready/By: Juris El See Page 2 for Internet: www.tigard- or.gov BV kr D CARD Notified/Method: Supplemental Information TYPE OF WORK �����r PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. . • CATEGORY OF 'CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural g 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 ", "I -2 ", "l -3 ", Job no.: Job site address: te9r S � ////4-",‘„,-,.. I or more. occupancy. ❑ Six x o or r more residential units. ❑ Recreational vehicle parks. City/State/ZIP: 77/10":" ��` � �' � ❑ Health-care facilities. as ❑ Supply voltage for more than fa/ ❑Hazrdous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: /�/'L 9 ❑ Service or feeder 600 amps or more. J .FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total li �� /y New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision -- Mefy Lot no.: 1,000 sq. R. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 . DESCRIPTION OF WORK (with above sq. ft.) - • Limited energy, multi- family residential (with above sq. ft.) 75.00 2 - Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER • I ❑ TENANT 200 amps or less 100.70 2 • - '�� 201 amps to 400 amps 133.56 2 , Name: /w / 401 amps to 600 amps 200.34 2 Address: x ✓ f( 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or Phone: ( ) Fax: ( ) relocation 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel M APPLICANT - I . ❑ CONTACT PERSON • 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: service or feeder fee, first branch circuit 56.18 2 Address: Each add'I branch circuit 7.42 2 City/State /ZIP: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Phone: ( ) I 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'�i I��� Signal circuit(s) or limited - energy �` « �� 7 �� �t/� �, i .anel, alteration or extension. Pa' e 2 15.E 2 Address: /64 5 e- 3� ✓ O \ft- Each additional inspection over allowable in any of the above Additional si inspection J � �� � Investigation ion ((1 I hr mmi hr (1 hr min) 66.25/ hr n) 66.25/ hr Phone: '? C, / � I Fax: ( - ) Industrial plant (1 hr min) 78.18 / hr Inspections for which no fee is 90.00/ hr CCB Lic6/4 .f 7 E lectrical69' CJ Suprv. Lic. 362 I S specifically listed (I hr min) vv . ' 'ELECTRICAL ' FEES Suprv. Electrician signature, require. Subtotal: Print name �� / � Lv - Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: Date: This permit application expires if a permit is not obtained within I80 days after it has been accepted as complete. • Number of inspections allowed per permit. I:\ Building\ Permits \ELC_PermitApp_040913.doc 440- 4615T(I 1 /05 /COM/WEB Electrical Permit Application — City of Tigard Page 2 — Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. 1 Fee I Total I Fee for all residential systems combined........ $75.00 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 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva (fee in accordance with OAR 918- 309 -0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over25 7.42 3 ❑ Vacuum Systems* >100 kva— no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/ hr charged at an hourly (1 hr min) Inspections for which no fee is 90.00 / hr specifically listed (%A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system • $75.00 subtotal: (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: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. * Number of inspections allowed per permit. ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ 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_PemutAPp_040913.doc