Permit CITY OF TIGARD MASTER PERMIT
2- COMMUNITY DEVELOPMENT Permit #: MST2013 00170
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2013
Parcel: 2S103BCO5800
Jurisdiction: Tigard
Site address: 12275 SW TIPPITT PL
Subdivision: TIPPITT PLACE Lot: 8
Project: Loewer
Project Description: Master bedroom and bathroom remodel
BUILDING
Floor Area Required Setbacks Required
Stories: 0 Bedrooms: 2 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $48,600.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 2 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: 2 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 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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
LOEWER, STEPHEN J & KATHRYN G TRNORTHLAND DESIGN & BUILD Required Items and Reports (Conditions)
12275 SW TIPPITT PL 20000 SW CAPPOEN RD
TIGARD, OR 97223 SHERWOOD, OR 97140
PHONE: 503 - 380 -6251 PHONE: 503 - 380 -6251
FAX: 503- 625 -4838
Total Fees: $1,647.02
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 acc• - - = 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. ATT • ION: Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0' through OAR 9 •-00 : • u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued : y: / t, � Permittee Signature: Al.■ _ : \.1 .:1 (
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.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Dat Received eB : 7Alimir � % Permit No.: M 5 -N'
�/ / 76
II °- 13125 SW Hall Blvd., Tigard,OR 97223- JUL 1 1 2013 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1 6 0 Date 7 �� Other Permit:
-1. 1 G A R D Inspection Line: 503.639.4175 CITYOFTIG Date Rea.. :y: Juris: El See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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
L( Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
,/ CATEGORY OF CONSTRUCTION work indicated on this application.
E t- and 2- family dwelling ❑ Commercial /industrial Valuation: S ) cc0
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i 2_2_1 r1 Q 1 E New dwelling area: square feet
City /State /ZIP: -- — c ... _.D___ Op. of - Z . 2 Garage /carport area: C75 square feet
Suite/bldg. /apt. no.: Project name: J Covered porch area 7 `/ square feet
Cross street/directions to job site: i ( .. f) Deck area: 0 square feet
��CU.‹CJ - St ) r)./r• \ 2 5V Q) on "Ti Other structure area: ( square feet
REQUIRED DATA: COMM ERCIAL -USE CHECKLIST
Subdivision: 2S c ' 5 - G� - � 1..O Z, 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
w l'nc V\/\l k` equipment, materials, labor, overhead, and the profit for the
' DESCRIPTION OF WORK work indicated on this application.
SZeV\A•OCaCA i•Aos ei Naed`roov\A ci bot+VI • Q. t Ylotll Valuation: $
• • we. `tion - v sz.c \ r`y vOt.r 1\S Vut Sayvvv, Existing building area square feet
(1 v .cos • va-d.d Cr..... two vt w nd VI .w (In r ei aS1CY bad+
SRCp\0.t'SL AU-) 0 P a(s,$t1Y10 J IA )•trldoL(_lC WI S►elr bef-IYOOM New building area: square feet
[3 PROPERTY OWNER I ❑ TENANT Number of stories:
Name:) E v kA k.QA A .p Type of construction:
Address: \' .2 t),) — r'f:pa"ry 't A-t✓_F Occupancy groups:
City /State /ZIP: •--r`c c _c O— c1 223 Existing:
Phone: ( ) 0 • (01...S l Fax: ( ) New:
❑ APPLICANT - CONTACT. PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: t or C I S # _ - �,, r \ ' Ni . _
� \���� -p
y J J
Contact name: ' Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Address: 200dp SO CO Y amok,
City /State /ZIP: Sv )0 ,.�„L r 9 ��� Total fees due upon application: y �
Wv or_ Amount received: 46
Phone: (5627) 321-3 , v..)a- k Fax: : ( j) CA5 L! 2 g
E -mail: C c> o7N0✓�l/1 t l Qcs r ow 6 l l.odt . covvk PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Comme ial and residential prescriptive installation of
CONTRACTOR roof -top m. • . ted Photo Voltaic Solar Panel Syst- .• .
Business name: r nn Submittwo(2)s .. of roof plan with tonne •.ndetails
t� CJ's C`�OC� �f J �� s - • and fire department ac -% along wit . e 2010 Oregon
Address: 2Q COO ski° cjo i) Qx�rP f� Solar Installation Specialty .. • • • ecklist.
City /State /ZIP: S �r C a d c of 9., l L ,. Permit Fee (includes re • $180.00
and ad istrative fees):
Phone: (5 3a , (e" a S l 1 Fax: (S) S ` State surch. •e (12% of permit fee): $21.60
CCB tic.: cz y,. )l 0 Total fee due upon application: =11.60
Authorized signature: OL 0 O,� This permit application expires if a permit is not obtained
`"� within 180 days after it has been accepted as complete.
A� I.�T (� Date: * Fee methodology set by Tri- County Building Industry
Print name:
p -V\ `\/� 9. \ �l ` \ c� �‘ 3 Service Board
I:\ Building \Perrnits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling .FOR OFFICE USE ONLY
City of Tigard Received permit No.:
Date/By:
, a 13125 SW Hall Blvd., Tigard,OR 97223 Associated permits:
C Phone: 503.718.2439 Fax: 503.598.1960 -
I' I G n K D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard - or.gov ❑ Other: ,
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/..A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. - ❑ ❑ ❑
7 Water district approval. El ❑ ❑
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.
1 I Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
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 maybe required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, 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 ap 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(I I /02 /COM/WEB)
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard r ecei"ed
laate/B y: 7 11 // 3 al. , i 'ermit N o i•�STao/ 3-D0 r / 7i
a 13125 SW Hall Blvd., Tigard, OR 97223 JUL 1 1 2013
2 Phone: 503.718.2439 Fax: 503.598.1960 � 13 i ; _ • er Permit No.:
T
Inspection Line: 503.639.4175 CITY OF i1GARD r ate Ready/By: hr Page 2 for
TI G A R D Internet: www.tigard or.gov BUILDING DIVISION otified/Method: � • upplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction Demolition For special information use checklist
Description I Qty. I Ea. I Total
Additio teratto replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
1- and 2- family dwelling t/ Commercial/industrial SFR (2) bath 437.78
Accessory building Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
Master builder Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities:
ob site address: ` 2_2 S 5 , 1 "r t 1 } c,., IT o , c Catch basin or area drain 18.76
ity/State /ZIP: -- 9 „ . �a dam- -- R. --R. . 222 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
uite/bldg./apt. no.: (Project name:
ross street/directions to job site: Manufactured home utilities 50.03
,�\ Mc �A� � --� Manholes 18.76
Caat/d 9 . l ::: )cn ,7 1 \ tr ) Cl Rain drain connector 18.76
-1-1p(5‘14- �� �� Sanitary (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
ubdivision: W ;Ad • A ILot no.: g Water service (no. linear It _) Page 2
Fixture or item:
ax map /parcel no.: ZS k (-) C - OS$ )o Backflow preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
M00-Q, IrIGOA \r - .(�X N eS \n yne \ r('(t Clothes washer 25.02
1 1YrN4 , cAOS∎It, . I=re rl c' ,0111KtS ' new \u.. ' ic(-.1 Dishwasher 25.02
Vkork 1 Skst\k• No S� �1t Drinking fountain 25.02
PROPERTY OWNER I TENANT Ejectors/sump 25.02
ame: f - Expansion tank 12.51
VV f' . ` Tti L--C3e w e• r Fixture /sewer cap 25.02
• ddress: 11..-2.: > SW - rt pr( -kt Pk :t C e. Floor drain/floor sink/hub 25.02
ity/State /ZIP: -- ri ` 0 <= Garbage disposal 25.02
I' hone: (0) 3-7-d av� C t Fax: .-5 . 1 ii SS' Hose bib 25.02
APPLICANT ✓CONTACT PERSON Ice maker 12.51
• usiness name: No i \ . d C cx't -.e, �,S` v rnterceptor /grease trap 25.02
_` ) "1Ciedical gas (value: $ ) Page 2
ontact name:' \.► >J Q
Primer 12.51
• ddress: 1.-I3 O O 1 7 • C r ' p d Roof drain (commercial) 12.51
ity/State /ZIP: _ k. a- \�\ L-kp Sink/basin/lavatory 25.02 3
P hone: 603 39-D. was \ ax :: (Sc c ,,, s • 1...v-Kt Solar units (potable water) 62.54
I -mail: ('�- Tub /shower /shower pan 12.51 2.
• ✓ • A IA ,' _ I _ ar A OU `�A� • CCa'rl Urinal 25.02
CONTRACTOR
Water closet 25.02 2
it usiness name: ‘ v1t ^��P \C S' \Y\�i • Water heater 37.52
`
' ddress: CAC) Nom' 11 --1,, p F Water piping/DW V 56.29
ity/State /ZIP: ��, .in - 0;:)( l ^ Other: 25.02
Slg • In to L L N
Subtotal
'hone: a x: ( )
CB Lic.: 1 1 -1 ‘‘...\ 7 q ('7 lumbing Lic. no.: 'Ql oyt,.�� Minimum permit fee: $72.50
Plan review (25% of permit fee)
Authorized signature: a State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Print name: . ..A - 1 This permit application expires if a permit is not obtained within 180 days after it
�a U. x t ra
I: \Building\Permits ' -Permi • pp.doc 10/01/09 • • I • • 16T I0 /07JCOM/WEB) has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
Electrical Permit Applicati SECENED FOR OFFICE USE ONLY
City of Tigard 1 . , re No. MST O , / ' - 3O / 70
,Il C ° 13125 SW Hall Blvd., Tigard, OR 9727 1 L 1 2013 r .
Phone: 503.718.2439 Fax: 503.598.1960 .
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD ID . e Ready/By: uris: L See Page 2 for
Internet: www.tigard- or.gov I otifted/Method: supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
New construction ✓Addition/. n/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
Demolition Other: Service or feeder 400 amps or more Building over three stories.
where the available fault current Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Floating buildings.
1 agdTfNItily dwelling Commercial /industrial Accessory building less to ground, or exceeds 14,000 Commercial - use agricultural
amps for all other installations. buildings.
Multi - family Master builder Other: Fire pump. Installation of 150 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 ", occupancy.
Job no.: Job site address: (2 Z'15 SW - cp - 1 - c - 0L 100HP or more. Recreational vehicle parks.
Six or more residential units. Supply voltage for more than
City/State /ZIP: — 3AAn1 Ock., Q 225 Health -care facilities. 600 volts nominal.
J Hazardous locations.
Suite/bldg. /apt. no.: Project name: Service or feeder 600 amps or more.
Cross street/directions to job site: Mc �an exAc:\ ..rn c._ v FEE SCHEDULE
Description I Qty. I Fee. I Total I •
C F) -• 12 1 ST ' ` )- CAC) — rvspP \ TV'. New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: ` ^' Lot no.: t2
V V t`n tk NAB % N - 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: •2S \ p -JreG O � QUO Ea. add'I 500 sq. ft. or portion 33.92 1
DESCRIPTION OF WORK Limited energy, residential
(with above sq. ft.) 75.00 2
AlattY u.Y0A,r-,cr W\O49.I,Y \\\,yam \GOB. Limited energy, multi- family
�� residential (with above sq. ft.) 75.00 2
M t71S\CY \oecivOO ■Acc 1 el . W Vet cOsr Y\e\tJ S %O.. Renewable Energy See Page 2
J PROPERTY OWNER I TENANT Services or feeders installation, alteration, and/or relocation
Name: C' 200 amps or less 100.70 2
2 -.2_-Ac. 201 amps to 400 amps 133.56 2
Address: \
G - v.l.. . 401 amps to 600 amps 200.34 2
Ci /State/ZIP:T 601 am to 1,000 am 301.04 2
Phone: (�j0 3) 3 � \ ax: ( Over 1,000 amps or volts 552.26 2
�' cOaS � � _ Temporary services or feeders installation, alteration, and/or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 200 amps or less 59.36 1
Owner signature: 201 amps to 400 amps 125.08 2
401 amps to 599 snaps 168.54 2
Date:
Branch circuits - new, alteration, or extension, per panel
APPLICANT I ✓CONTACT PERSON A. Fee for branch circuits with
Business name: above service or feeder fee, each
NIO \ CX CCre5 ;CCI TA \5VI t k r C` C . branch circuit 7.42 2
: , -c+
Contact name: _ -
� V B. Fee for branch circuits without Q,
t
�� service or feeder fee, first 1 56.18 , 5 lO \ 1/ 2
Address: 2.0 t:.00::, c 7 c cuecoexi v branch circuit
City/State /ZIP: Each add'I branch circuit ,5 7.42 ,3,34,n 2
S�e •�y Q g Q J a , 4' Miscellaneous (service or feeder not included)
Phone: (Gp(5 r p (c7a ax: : ( ) E ach manufactured or modular
503 L O as 4�3� 67.84 2
E -mail: 9--C-r3. �J'C_�NGC1Irk `� AC1 t, � ' dwelling, service and/or feeder
� ----- -- • Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84 2
Business name: C.A..7tA'„ L C \e ; G Sign or outline lighting 67.84 2
Address: Signal circuit(s) or limited -energy See
Qd panel, alteration, or extension. Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
ty � ��A. � OYZ � �' \d � P Y
Phone: (s : 4 . . \ %O0 jFax: ( � 3) .6 . 0 J3 et Additional inspection (I hr min) 66.25/ hr
1 Investigation (1 hr min) 66.25/ hr
CCB Lic.: k t.,"\ `Electrical Lic.: ( 1 cciSuprv. Lic.:'SO Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
Suprv. Electrician signature, required:C p , A A A specifically listed (V2 hr min) 90.00/ hr
ELECTRICAL PERMIT FEES
Print name: G _0 c.„., kTAr, !ate: q, I 1 . 1 Subtotal:
Authorized signature: OZ. A . n /� Plan review (25% of permit fee):
1" ` State surcharge (12% of permit fee):
;
Print name: A..-\' Date: - 4.e9 laoL3 TOTAL PERMIT FEE:
r
Mechanical Permit Application Received
FoR OFFICI USE ONE)
RECEIVED
114 - Phone: 503.718.2439 Fax: 503.598.1960 III City of Tigard Date/By:
No.: ILL � / co '41 ° 13125 SW Hall Blvd., Tigard, OR 97223 v ��
Plan Review
2 5 2013 Datc/By: Other Permit
Inspection Line: 503.639.4175 �!. D Read 3uris ®See Pa e 2 for
- T +GARD Ready/By: g
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
�]
CITY OF TIGARD
l��
TYPE OF V1'Iriil DIt�G DIVISION 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: $ $300.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- 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:
Air conditioning 46.75
Job site address: 12275 SW Tippitt Place Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: Tigard, OR 97223 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: Gaarde , right onto 121" left onto Tip Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) - - 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Windmill Lot no.: 8 Other: 23.32
Other fuel appliances:
Tax map /parcel no.: 2S103BCO5800 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace /insert 33.39
• Flue vent for water heater or gas
2 bathroom fans: master toilet room and hallway bath 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 ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Steve and Kathy Loewer Range hood /other kitchen
equipment 33.39
Address: 12275 SW Tippitt Place Clothes dryer exhaust 33.39
City/State /ZIP: Tigard, OR 97223 Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 2 23.32 46.64
Phone: ( ) Fax: ( ) Attic /crawlspace fans 23.32
❑ APPLICANT _ ® CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Northland Construction & Design, Inc
$14.15 for first four, $4.03 for each additional
Contact name: Rod Loewer Furnace, etc.
Address: 20000 SW Cappoen Rd Gas heat pump
Wall /suspended/unit heater
City /State /ZIP: Sherwood OR, 97140 Water heater
Phone: (503) 380 -6251 Fax: : (503) 625 -4838 , Fireplace
Range .
E - mail: Rod @NorthlandDesignandBuild.com Barbecue
•
. CONTRACTOR Clothes dryer (gas)
Business name: Jeff's Heating & Cooling Other:
MECHANICAL PERMIT FEES* .
Address: 22885 S Tendril) Subtotal 44•
City/State /ZIP: West Linn, OR 97068 Minimum permit fee ($90.00) CNC--
Phone: (503) 557 -4635 t, L Fax: (503) 557 =3870 Plan review (25% of permit fee)
Fi--' State surcharge (12% of permit fee)
CCI3 lit.: 99132 ( 1 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: 11 • Fee methodology set by Tri -County Building Industry Service Board
Print name: Ali Metcalf Date: 7/22/2013 .
I: 113.doc 440-4617T (1 I /02/COM/W EB)