Permit CITY OF TIGARD MASTER PERMIT
I. 8 - COMMUNITY DEVELOPMENT Permit#: MST2013 00188
Date Issued: 08/21/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S110DD03600 iliar'
4 I I 4 Jurisdiction: Tigard
Site address: 10450 SW CENTURY OAK DR
Subdivision: SUMMERFIELD Lot: 43
Project: Peterson
Project Description: Interior remodel. 9/24/13, adding service panel
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: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $15,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 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: 2 Clothes Dryers: 0
Heat Pump: N Hoods: 1 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'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1
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:
PETERSON,HERBERT OWNER Required Items and Reports(Conditions)
10450 SW CENTURY OAK DR PETERSON,HERBERT
TIGARD,OR 97224 10450 SW CENTURY OAK DR
TIGARD,OR 97224
PHONE: 503-516-7375 PHONE:
FAX:
Total Fees: $856.24
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 ' accordance 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. ATTENTION: Oregon =w req ' - you to follow the rules adopted by the Oregon Utility Notifica'+n Center. Those rules are set forth in OAR
952 101-0010th •ugh OAR 952-0.1 s 190. Y•u obtain a copy of the rules or direct questions to OU • by call••,4.03.232.1987 or 1.800.332 344.
I i
1ss ac By: �r�� //Lar�// Permittee Signatu =: _ ' ' £.1Ai
Call 503.639.4175 by 7:00 a.m.for the next available Insp. .•. •. /
This permit card shall be kept In a conspicuous place on the job site until corn. on of the project
Approved plans are required on the job site at the time of each Inspection.
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2013-00188
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 2S110DD03600
Jurisdiction: Tigard
Site address: 10450 SW CENTURY OAK DR
Subdivision: SUMMERFIELD Lot: 43
Project: Peterson
Project Description: Interior 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: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $15,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 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
Bckfiw 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: 1 Other Units: 0
Fum<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: 1
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:
PETERSON,HERBERT OWNER Required Items and Reports(Conditions)
10450 SW CENTURY OAK DR PETERSON,HERBERT
TIGARD,OR 97224 10450 SW CENTURY OAK DR
TIGARD,OR 97224
PHONE: 503-516-7375 PHONE:
FAX:
Total Fees: $798.07
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N 'cation enter. Those rules are s t.-forth in OAR
952-001-0010 throug A 2-001-0 90. You may obtain a copy of the rules or direct questions to OUNC by cal'rig 503.287 qr 1.800.332 344
Issued By: Permittee Signature: 04
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.
-Boiling Permit Application
Residential RECEIVED FOR oFhlcF, USE ONLY
City Of Tlgard Re erred I Permit No.: 2
° (3125 SW Hall Blvd.,Tigard,OR 97223 .4„..,,,,,m,
--m �� , J ���
g Plan Revie •,Iry
III
Phone: 503.718.2439 Fax: 503.59 0 8 2013 Date/B -,�ik'Iv rt IN Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Re.'i : �y / t�� Juris: El See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: 3 Supplemental Information
� b 0 �6
B I DIVISION TYPE F 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
[Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION - work indicated on this application.
K1-and 2-family dwelling CI Commercialindustrial - Valuation: $ 15 COD
2.
ID Accessory building ❑Multi-family Number of bedrooms:
El Master builder 11 Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: /32_2_ square feet
City/State/ZIP: Z 9 , r o- q,7L1c Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ! gatttowy 4,T�2 d.6)■ Covered porch area Z‘ square feet
Cross street/directions to job site: l0 1 6_0444�, Rd Deck area: g square feet
wYGI�*I/H Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
1 Subdivision: /1!jIfE..04:I&) 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.
h..,lea l(a 7 -4 46/1-tCi g /LiAitCeg Z.621 iP 1jr/f Valuation: $
Existing building area square feet
New building area: square feet
cp PROPERTY OWNER _ ❑ TENANT Number of stories:
Name: E /..274ZE,e4col Type of construction:
Address: /0��J S ,le',n AfFet 444---01_.... Occupancy groups:
City/State/ZIP: /7V-0p ' Oh/ (9fPl4" Existing:
Phone:(Sab 4'14„.....73-7S- 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: il /96 .°
E-mail: ,PHOTOVOLTAIC SOLAR PANEL SYSTEM,FEES*
CONTRACTOR • mercial and residential prescriptive installat: of
roof-to• iunted PhotoVoltaic Solar Panel -'stem.
Business name: Submit two •- of roof plan with c• ection details
and fire department a -•ss,alon: I the 2010 Oregon
Address: Solar Installation Specia ') ,,e checklist.
City/State/ZIP: Permit Fee(inclu. p1. . view $180.00
and .• inistrafive fe• •
Phone:( ) � ( ) State sure ge(12%of permit fee): $21.60
CCB lic.:
otal fee due upon application: $201.60
Authorized signatu . This permit application expires if a permit is not obt:fined
within 180 days after it has been accepted as complete.
Date: *Fee methodology set by Tri-County Building Industry
Print name: '' /��s� 8/8//3 Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440.4613T(l 1/02/COM/WEB)
Building Permit Application Checklist '
One- and Two-Family Dwelling FOR .OE ICE USE ONLY
City of Tigard Received Permit No.:
V 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By.
' 0 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 a Other:
THE FOLLOWING ITEIVI:S ARE REQUIRE{) FOR I LAN.REVIEW • is 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 Dr authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit.''`'''c:' ❑ ❑ ❑
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-fl. 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 applicable 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 I 1"'or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Buildingplans 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 RECEIVED FOR OFFICE Usl, ONLY
City of Tigard Received a Permit No.: �/G���� ��/
Ill 13125 SW Hall Blvd.,Tigard,OR 97223 nn ilk
Date/By: / 3 ► [ -mot 0U/4_�/d f
1 gi Phone: 503.718.2439 Fax: 503.598.196j. G 8 2013 Plan Review Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARI) Notified/Method: Supplemental Information
TYPE OF w4Uj ILDING DIVISION 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
❑ 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:
Catch basin or area drain 18.76
Job site address:
ito 4741cp S- (0 @2ar?jte 044 Drywell,leach line,or trench drain 18.76
City/State/ZIP: �Q /�
r 7 A��� d2- ,-)-772-7"(74 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Q__eryL Manufactured home utilities 50.03
Cross street/directions to job site: - Manholes 18.76
I° t it.ei/ ^ P.O 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: P4.114 eLQt Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
•DESCRIPTION OF WORK Backwater valve 12.51
l� p��' Clothes washer 1 25.02
(C ITCA) AN v I T %AO b (NU)D(►JG Dishwasher 25.02
lA> SAO UJ PGU 5 A.DD(1J C Drinking fountain 25.02
101-2 it dS LA Vo p iZ,If Ejectors/sump 25.02
Q1 PROPERTY OWNER ' I ❑ TENANT Expansion tank 12.51
Name: &o- -- . j Fixture/sewer cap 25.02
( �""^"'"` Floor drain/floor sink/hub 25.02
Address: / 'L/ 2 S . 0_ y£74 cb✓L Garbage disposal 25.02
City/State/ZIP: r 9A C�� Hose bib 25.02
Phone:( 3) S(6,!, 17.r. 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 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
CONTRACTOR
Water closet 25.02
Water heater 37.52
Business name: • Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: 4(4% L' Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 'lumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signal � TOTAL PERMIT FEE
Print name: Date: 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\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-I'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:
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
-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
4" ❑ 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: -LavBar 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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
l:\BuildingWermits\PLMF_PermitApp.doc 08/04/2011 2
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED DateBy: �� Permit No.: H7.---,•,,,/3 90/•rt 13125 SW Hall Blvd.,Tigard,OR 97223 y
Plan Revie
C Phone: 503.718.2439 Fax: 503.598. Other Permit:
���'� 8
Date/By:
III T 1G A R D Inspection Line: 503.639.4175 O 2 13 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITYOFTIGARD Notified/Method: Supplemental Information
• TYPPU'PIS 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:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
�/� Air conditioning 46.75
Job site address: ( ' 2 '' s'.(.a - 6440 M/ O4 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: --ri9,4 go D12-- 91 Furnace 100,000+BTU(ducts/vents) 54.91
f ! Heat pump 61.06
Suite/bldg./apt.no.: Project name: f -(�.esoli , C[_ Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
r Residential boiler(radiator or
1 O(6.-1' 9 b4,,1, I '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
Other: 23.32
Subdivision: -CC 'LF(r?-7/-4 Lot no.: 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
P��CA76 Al I- gl�� ,`�z/,5-7e fireplace 23.32
{ l�� 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: 6e-iiset-r— -o..-11 ,say.) Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust _ 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT a CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. _
Gas heat pump
Address: -
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other: i
Business name: -
MECHANICAL PERMIT FEES*
Address:
,, 1 Subtotal
City/State/ZIP: b�/t/��/ Minimum permit fee($90.00) -
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: 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: l_.. • Fee methodology set by Tri-County Building Industry Service Board
Print name: Date:
1:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I 1/02JCOM/VEB)
Mechanical Permit Application - City of Tigard
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
EleotFical Permit Application REc
EIV FOR OFFICE USE ONLY
�''eceived ev G /
City of Tigard Date/By: b p /3 / PermitNo.: Fgt.) 3-0:187(
° 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 8 Plan Review
' Phone: 503.718.2439. Fax: 503.598.1960 `�13 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: • Juris: ® See Page 2 for
'1'16 AKI3 g g CITYOFTIGARII Notified/Method: Supplemental lnformafion
Internet: www.ti ard-Or.503.639.4175
BUILDINGDNISION,, PLAN REVIEW
' .. .,. TYPE�OF WORK ,
❑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
\XI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building 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"
Job no.: --- Job site address: 1,01450 •`ova CfrNN URA' 01%-,c 10OHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -'r(b p ci)) OIL 1 7 ZZ{ ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: itV.SeZ .. orJ ( Ann J I - ❑Service or feeder 600 amps or more.
Cross street/directions to job site: (r t� r� ►� ,A w X6412 T FEE'SCHEDULE
J 1U�T� /�N D Dv R..4-1 rn+��,�,1�+9�v�.�/ J Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
SV M M�fL-F(E Lb _1,000 sq.ft.or less 168.54 4
Subdivision:— Lot no.: - —
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
sq. 75.00 2
DESCRIPTION•OF'WORK . (with above q•ft)
vRAI� L 15?IIJ Limited energy,multi-family 75.00 2
OY'• ., G 1ZS�A PAS L lb 2.0Dk t L KAI NJ residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Q,& A, FUR. Ab9�bl fcIT• p,�1,b BATH CJQ 411 ITS J L I G w- I�G Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER •il ❑'TENANT 200 amps or less 100.70 2
— 201 amps to 400 amps 133.56 2
Name: `� (LcTSO IJ 401 amps to 600 amps 200.34 2
Address: (09 c ) SW c .- 1 2Y OA 601 amps to 1,000 amps 301.04 2
n � Over 1,000 amps or volts 552.26 2
City/State/ZIP: Z ( GPO-Lb ofL of 7 Z2 Li Temporary services or feeders installation,alteration,and/or
Phone:(5v3) 7 57 S Fax:( -4----
relocation
200 amps or less 59.36 1
Owner insta ation:Thi installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for s. e,lease,r:1 or exch. rrding to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature* y 4„./..° e Date: Branch circuits-new,alteration,or extension,per panel
,.❑ 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 1 56.18 2
branch circuit
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:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
. .•" ' ,CONTRACTOR , .. , . ' ' : 1 Sign or outline lighting 67.84 2
Business name: OW 0 fif7` Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Alt__ J1/4S ^R'CoNii Each additional inspection over allowable in any of the above
^�t� Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Investigation(1 hr min) 66.25/hr
Phone:( ) • Fax:( ) Industrial plant(1 hr min) 78.18/hr •
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(A hr min)
.ELECTRICAL;PERMIT 1FEES . . ' `
Suprv.Electrician signature,required: Subtotal:
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/1VEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
'RESIDENTIAL WORK ONLY • i FEE SCHEDULE
I
Fee for all residential systems combined ... $75.00 Description. I Qty. 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*
1 5.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 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
charged at an hourly(I hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
_ specifically listed(Vs hr min)
( COMMERCIAL WORKONLY: . I . ,_,'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
❑ Data Telecommunication Installation •
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
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�/ 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 hom eowner statement is true and accurate.
rint Name Permit Applicant
Signature of Permit Applicant Date
Permit#: H •0 I 3' DO IV
Address: 104 e_A.kyruu2`/ 4-K71)0_, ■;
t• l 1bfi27J CSR- (7i�+�:�rry •N
Issued by: Date: ePAA3 C1
This Copy for Permit Offices
Inspections Required for: j!J6 j 2/2? co?s INSPECTOR'S SIGNATURES ARE NOT
(/ REQUIRED ON GREEN INSPECTION CARD.
✓ I Code Inspection Description I PASS Date I By
MST - Master Permit
750 Initial erosion control
405 Excavation
410 Fill
415 Grading
205 Footing
•
805 MFG-Structure grading/footing
210 Foundation walls
215 Footing drain
305 Plumbing underslab
105 Underground/slab cover
•
220 Slab
310 Crawl drain
315 Post/beam plumbing
605 Post/beam mechanical
225 Post/beam structural
230 Underfloor insulation
235 Shear walls/anchors
240 Exterior sheathing
242 Interior shear walls
245 Firewall
250 • Roof nailing
255 Wtr proofing basement walls
265 Masonry
V 320 Reinforcing steel(rebar)
Plumbing rough-in
322 Shower pan
610 Gas line
615 Mechanical rough-in
110 Temporary electrical service
115. Electrical service
120 Electrical rough-in
135 Low voltage
91 Sprinkler rough-in
275 Framing
810 MFG-Structure set-up
280 Insulation
330 Water service
335 Rain drain
340 Storm drain
505 Sanitary sewer
•
350 Septic tank
285 Drywall nailing
289 Approach/sidewalk
295 Misc.inspection:
899 MFG-Structure final
498 Grading final
Final erosion control
Mechanical final
✓ 3 9 Plumbing final
9 Electrical final
"Vi2j399 Final inspection
•
•
I:\Building\Inspection Cards\MST Insp Case By Case\InspCard_MST_Blank_070112
SITE COPY
•
•
•
•
I:\Building\Inspection Cards\MST Iinsp Case By Case\InspCard_MST_Blank_070112
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10450 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Master Permit
699 Mechanical final
PASS
MST2013-00188
David Young
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10450 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Master Permit
299 Final inspection
FAIL
MST2013-00188
David Young
Provide approved electrical final.
Provide timer or de- humidistat switch for master bath fan.
Fasten dishwasher hose to top of cabinet.
Provide weatherproof covering for entry.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10450 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Master Permit
399 Plumbing final
PASS
MST2013-00188
David Young
Note: for building final, dishwasher hose to be securely anchored to underside of cabinet
top. 807.4
Violation Summary:
Inspector Contractor