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Permit CITY OF TIGARD MASTER PERMIT iiik •. COMMUNITY DEVELOPMENT EIIISED Permit#: MST2013-00197 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 /a//?//j /371 Date Issued: 09/05/2013 Parcel: 25111 AA02700 Jurisdiction: Tigard Site address: 8630 SW GREENSWARD LN Subdivision: GREENSWARD PARK Lot: 11 Project: Azimi Project Description: Cover atrium and relocate kitchen. 10/14/13: Reprinted: add(1)service panel, (1)water heater, (1)gas outlet for water heater and(1)furnace. 10/17/13, Reprinted;to change listed contractors. 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: $30,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 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: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 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 asin N Other: N Other Description: Ecom P g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: • Square Feet: ALT SF VB R-3 0 Owner: Contractor: DINDAR-AZIMI,FARAMARZ AND RASHI CRAFT MASTER LLC Required Items and Reports(Conditions) 8630 SW GREENSWARD LN 6663 SW BEAVERTON HILLSDALE TIGARD,OR 97224 HWY#220 PORTLAND,OR 97225 PHONE: 503-804-8481 PHONE: 503-997-7172 FAX: 503-292-1177 • Total Fees: $1,626.93 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 Notification Center. Those r s are set forth in OAR 952-001-0010 throue• •:' 952-001-0090. You may obtain a copy•'i • ••rest questions to OUNC by calling 503.232.1987 or 1.800.33 - 44. Issued B •-- — —mss=�' Permittee Signature: Call f 7•411,11!y 7:00 a.m.for the next available Inspection date. - I/ This permit card shall be kept in a conspicuous place on the Job site until compl:. •∎ • the proj:• Approved plans are required on the job site at the time of eac i ion. / I11 CITY OF TIGARD � MASTER PERMIT I COMMUNITY DEVELOPMENT Permit#: MST2013 00197 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 :� Date Issued: 09/05/2013 Parcel: 2S 111 AA02700 Jurisdiction: Tigard Site address: 8630 SW GREENSWARD LN Subdivision: GREENSWARD PARK Lot: 11 Project: Azimi Project Description: Interior remodel: cover existing atrium and relocate kitchen. 10/14/13, reprinted to add(1) service panel, (1)water heater,(1)gas outlet for water heater and(1)furnace. 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: $30,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 1 Water Lines: 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: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 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 8 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: DINDAR-AZIMI,FARAMARZ AND RASH! OWNER Required Items and Reports(Conditions) 18520 DELENKA LN LAKE OSWEGO,OR 97034 PHONE: 503-804-8481 PHONE: FAX: Total Fees: $1,269.27 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. ATT : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-00 1010 through•'- 952-00 1090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344. Issue, By: �k �_ !/� , . �`._ Permittee Signature: ( C.�/ J 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. Oct 15 13 07:21p Craft Master Construction 503-292-1177 p.1 Building Permit Applicat.i n,1 v, Residential �� >__,!, ') i `,5 i! , i, FOR OFFICE USE ONLY City of Tigard (�(` Received .� ( 2013 Permit No.: S�'Z4) _ e0 g �,{,t �y 2013 I J Date�By; ° 13125 SW Hall Blvd.,Tigard,OR 713.3 Plan Review Phone: 503.718.2439 Fax: 503 598.1960 DateBy: Other Permit: Inspection Line: 503.639,4175(;j i% r � j Date Ready/By: kris, See Page 2 for T I G A R D �,tl e Oi J,'L-4_,,-^,] Notified/Method: Soppkmcntal Information Internet: www.tigard-or.gov_„t-� �,�.� .,,,, �.-,-\c., TYPE OF WORK REQUIRED DATA:l-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rotrtded 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. Valuation: S ❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ['Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 8673 5G._) ,,-- �;-1.5 4.-.. i `. L;^ New dwelling area: square feet City/State/71P: J,, ' - --, L Garage/carport area: square feet ty --/—,.?y; �, r . Suite/bldg./apt.no.: I Project name: A 2.i‘,,.,,, Y t_.M O r, j Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: S (- Existing building area square feet ./ in...i -di / ■ Mili — New building area: square feet ❑ PROPERTY OWNER 0 TENANT • Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/Z[P: Existing: Phone:( ) Fax:( ) New: [<APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (1 (Please refer toferre/redule) Business name: Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax: :( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES' E-mail: Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: r-,�C-4- )\✓',q s'�e y-- !-1 -L Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: /�0 2 j a) d.e,_-_-;v-c,--.1i.., i/ri=!? ,"--.:,7 ->: 2Z 0 Solar Installation Specialty Code checklist. i Permit Fee(includes planreview PoY-=1 e„,: , :]!ti Cj-;`-. ._. and administrative fees): 5180.00 Phone:(S-63) G i--7;7 7 Fax:( :) -2-- ? - 1.'7-7 State surcharge(12%of permit fee): $21.60 CCB lie.: 19 7 • q u s't0/l4 Total fee due upon appication: 5201.60 ";- This permit application expires if a permit is not obtained Authorized signature:, -� within 180 days after it has been accepted as complete. -. *Fee methodology set by Tri-County Building Industry Print name: tjr,1,0.,L „_ c, '�„i,' Date: /0-!5 _ (a r� Service Board. I:113uildmg\Permitsd3UP-RESPermitApp.doc 02121/2011 440-4613T(I 1/02/COM/WEB) Oct 15 13 07:21p Craft Master Construction 503-292-1177 p.2 Mechanical Permit Applicati i t.(M, I i�_U y', FOR OFFICE, USE ONLY =q , City of Tigard � i - Received m Permit No.Al 5 7—�p/3— pv'9 - . ill 't 13125 3125 SW W Hall Blvd.,Tigard,OR 97223 r i Plan Review . C. Phone: 503.718.2439 Fax: 503.598.19600 C I li „ >xrte/By: Other Permit: Inspection Line: 503.639.4175 luris: 63 Sec Page 2 for TIC Internet: www.tigard-or.gov Notified/Method: Supplemental Information rn ---,, ,,,, -,--i-,-, ,-7-v., TYPE OF WORK COMMERCL%L FEE* SCHEDULE - USE CHECKLIST ,� Mechanical permit fees*are based on the value of the work El �- 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:S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* [al--and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use ckeck/isr. ❑Multi-family El Master builder ❑Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: t� Air conditioning 46.75 Job site address 3030 '3,�3 (''' 5 '�,�.)�=r C' �vn . _Furnace 100,000 BTU(ducts/veins) 46.75 Furnace 100,000+BTU(duets/vents) 54.91 City/State/ZIP: l✓ G,� _r ,.� •`'y' Heat pump 61.06 Suite/bldg./apt.no.: Project name: A.,.,,., y-,' ; .r.,..„.,.....-_, Ductwork 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,to-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: I Lot no.: Other fuel appliances: Tax map!parcet no.: Water heater 23.32 DESCRIPTION OF WORK Gas fiireplaceinsert 33.39 Flue vent for water heater or gas fireplace 2132 , 011)Lei 4,.....----- ----)L. i Log lighter(gas) 23.32 Wood/pellet ce/in 33.39 f Wood fireplace/insert 23.32 t Chimney/liner/flue/vent 23.32 Other 23.32 CI PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: 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 Gas heat pump Address: WaWsuspended'unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range t t,o E-mail: Barbecue N. CONTRACTOR /Jib 4- f}/0,... i fit- Clothes dryer(gas) 1 s Other. \ Business name: r hC�._ e,,,,,_ ..r ,�,,_• ,n R• t�' MECHANICAL PERMIT FEES*_ .Ms Address: //�` .,1 _ 6 0-4.1." ,/ t Subtotal < .. ice.�+*�•' . ..-'.s , Minimum permit fee(S90.00) I City/State/ZIP:' ,+ `� r t!�°. '.,�' , fC • 1=--+ ti _ (`O� Plan review(25%of pemtit fee) O Phone: ,, `*1^ '^--:� '4. > Fax:( ) State surcharge(12%of permit feel �� F 7 -'trt�- ,.-� q f'?l/y TOTAL PERMIT FEE CO3 lie.: This permit application expires if a permit is not obtained within ISO .�. '•�-' days after it has been accepted ns complete. Authorized signature: ��,!�' Z:,,, ,,„ 7" �'A i- ^ ' Fee methodology set byTr•-County Building Industry Service Board Print name: .. ... `K . - -z� • :+ . Date:t " - " t:U3uitding\Permi tsVaC Joni lApp_040113.doc 440.461 7T(I I/02;COMIw'ES) Oct 15 13 07:21p Craft Master Construction 503-292-1177 p.3 Plumbing Permit Apr.licatioq Ecp r n 3�. t _ . .. .. Building Fixtures �. D FOR oFFlce use c►nIa City of Tigard OCT 16 2013 eivey PemritNo.: M`')T-2..c)13-0,/9 7 114 2 .r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.7182439 Fax: 503.59819 Other Permit No.: �.�PY 0�TfG�RD Dale tta T 1 G A R D Inspection L ire: 503.639.4175 Date ReadylBv: mds: 0 See Page/for Internet www.tigard•or.gov BUIL.DIRI(f!`f ini\? Notified/Method: • Supplemental information TYPE OF WORK FEE" SCHEDULE ❑New construction ❑Demolition For special information use checklist. 7 Description I Qty. I Ea I Total Q Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for etch utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 I21-- SFR(2)bath 437.78 and 2-family dwelling ❑CommerciaVindustrial 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 r'°L;.-, Job site address: ,��;^";.:� 5'� ;� •1==.� �-�'` Drywell,leach line,or trench drain 18 76 , City/State/ZIP: `7:n c = C. t-' Footing drain(no.linear ft.:_) Page 2 _Suite/bldg./apt._no.: Project name: }` ■;° ' ;... -.. _J^,? / Manufactured home utilities 50.03 _ Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:____J Page 2 Storm sewer(no linear ft: ) Page 2 Water service(no.linear II.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow presenter 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 A , Dishwasher I 25.02 t, � � w 1 l Drinking fountain 25.02 I . tV.-1 Ejectorsisump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: Floor drainifloor sink/hub 25.02 Address: 25.02 Garbage disposal City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$^) Page 2 Business name: Primer 12,51 Contact name: Roof drain(commercial) 12.51 Address: Sinlubasilt/lavatory [ 25.02 City/State/ZIP: Solar units(potable water) 62.54 • ' Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: Water closet 2502 CONTRACTOR Water healer 37.52 Business name: &lcGe_t be C. , ,i,-1 (xi v L---<-C- Waterpiping/DWV 56.29 Address: 826 q W C' f 0-u5 b/L,z._ Other: 25.02 City/State/ZIP: Ele � - -r c/ 1 O o Subtotal Phone:(.9"?) ( If j 3 L/T5 1 Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fcc) CCB Lic.: 11.5.'762T ,II I6 Plumbing Lic.no.: Pij 3 "1 1v State surcharge(12%of permit fee) Authorized signature:��--GZs f- t _ . TOTAL PERMIT FEE Print name: c e7 �""� Date: /0-/.. This permit application expires if a permit is not obtained within 180 days �5 iTf� ,�G(6E'•- w "'�3 after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board 11 Building'3crmits1PL3411-Pei itA1p.doc 10/01/09 440'451 ET(1oioacOMM'EB) CITY OF TIGARD MASTER PERMIT I s : COMMUNITY DEVELOPMENT Permit#: MST2013-00197 T LGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2013 Parcel: 2S111AA02700 Jurisdiction: Tigard Site address: 8630 SW GREENSWARD LN Subdivision: GREENSWARD PARK Lot: 11 Project: Azimi Project Description: Interior remodel: cover existing atrium and relocate kitchen 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: $30,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 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: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 8 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: DINDAR-AZIMI,FARAMARZ AND RASH! OWNER Required Items and Reports(Conditions) 18520 DELENKA LN LAKE OSWEGO,OR 97034 PHONE: 503-804-8481 PHONE: FAX: Total Fees: $1,474.36 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 Notification Center. T.ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain - •• •r direct questions to OUNC by calling 503.232.1987 or 1 :00.332.2344. Issued B �� Permittee Signature: ...Agar/ r.11 "c_''5 by 7:00 a.m.for the next available inspection Pr This permit card shall be kept in a conspicuous place on the job site until • etion o'the project. Approved plans are required on the job site at the time of eac Inspectlo Building Permit Application Residential Foli.orFlcF. use ONLY T , City of Tigard RECEIVED Date/B : Ct �0 Permit • No.: 3rg )/3-od/7 2 ° 13125 SW Hall Blvd.,Tigard,OR 972 3 `' Plan Review , C.- Phone: 503.718.2439 Fax: 503.598. 6 L g n DateB : m��A Other Permit: 2 .J 13 lung: ® See Page 2 for T I G n R D Inspection Line: 503.639.4175 Date ReadyBy, g Internet: www.tigard-or.gov CITYOFTIG Notified/Method:Ready y /I? Supplemental Information BUILDI DNIS p1V d -{zr ''i•rye.,7' TYPE OF WO 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. 12K-and 2-family dwelling ❑Commercial/industrial Valuation: amp oa El Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION II Total number of floors: Job site address: '6'6 3Q ' .k), Gf eQvtco t(d Let ntie_ New dwelling area: square feet City/State/ZIP: 1-14/./. d p p 413221- Garage/carport area: square feet Suite/bldg./apt.no.: ((JJ Project name: Covered porch area square feet Cross street/directions to job site: q1/ b,v� Deck area: square feet Other structure area: square feet REQUIRED DATA:'COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the n - ' DESCRIPTION OF WORK work indicated on this application. C6ver a v. e X fi, Miff;J/w.. 'TO PloJ� it-7 Valuation: S k,4 ```( Existing building area square feet l..,,t ever, New building area: square feet lir PROPERTY OWNER ,❑ TENANT • - Number of stones: Name: 7 (t yvtelt/'Z Z I Al 1 Type of construction: Address: gj'(Q 0 � i,J , al/e�:v 3 Wa (d. (a t1 Q. Occupancy groups: City/State/ZIP: C dd jQ 4.72 [ Existing: Phone:(503) Jq. V-f••S'( 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: Total fees due upon application: City/State/ZIP: Amount received: c , s Phone:( . ) Fax: :( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* • Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: Q Cl.) 1 ) (72 Submit two(2)sets of roof plan with connect••• •etails and fire des:.• ent access,along wi • e 010 Oregon Address: Solar Installation , 'al _..e checklist. City/State/ZIP: Permit -: • c ude . • review $180.00 an. as inistrative - Phone:( ) Fax:( ) o State surcharge(12%of permit fee): $21.60 CCB lie.: i Total fee due upon application: $201.60 Authorized signature. �J This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ,!", TZ)M Date: L� *Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) 1 .. Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE.USE ONLY • City of Tigard Received Permit No.: II a 13125 SW Hall Blvd.,Tigard,OR 97223 Date .y. ': 13 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical I G A R D 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. ❑ ❑ El 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El 6 Sewer permit. ❑ _ CI ❑ 7 Water district approval. ❑ El 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- El El ❑ 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. I 1 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 ❑ El ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El El ❑ 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- El ❑ El 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. ❑ El ❑ 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 El ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered El ❑ El 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. El ❑ El 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ El ❑ 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 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 for Item 11 above. Site plans must be 8-1/2"x II"or 11"x 17". ❑ El ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. El ❑ El 25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ El ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ El ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. El El ❑ 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, ❑ El ❑ 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) Mechanical Permit A lic FOR OFFICE USE ONLY 1,1 City of Tigard Date/By:13125 �, 4 7 C ° 13125 SW Hall Blvd.,Tigard,OR 97223 IdQ� 8 EIVEh Plan Review Phone: 503.718.2439 Fax: 503.598. ' 2 2013 Received � Date/By: Permit No.: Other Permit: T I G A It D Inspection Line: 503.639.4175 Date Ready/By: luris ® See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD 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 1:1 ❑New construction Ad dition/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 ❑CommerciaUindustrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: '(e c7 ` ./ cfe....evt 5 (,(far d if __ Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-714i d '� 72 Z[{ 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: /4 // 61v' . Hydronic hot water system 23.32 of 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert I 33.39 /'+� � Flue vent for water heater or gas l-aver cr+1 AV4-e;IJrwt gam, sf,„ ,z_ 7 /4C1,,, 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: toff-0'w a r z_ A Z1,� Range hood/other kitchen equipment / 33.39 Address: r 3O ,I„J , r,cQ,,,vS W a s'c Lc ,.t,L_ Clothes dryer exhaust 33.39 City/State/ZIP: 7-7113t/Q t� .17 ZZc- Single-duct exhaust(bathrooms, 2 I toilet compartments,utility rooms) --.7 23.32 Phone:(503) ip:,Gf_ ZLt--'1 Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel pi Business name: $\ 14 115 first four;$4.03 for each additional Contact name: Fumace,etc. _ _ _ Gas heat pump — - Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax: :( ) Fireplace I Range E-mail: Barbecue ./ .__ CONTRACTOR Clothes dryer(gas) . Other: Business name: OWP,--,r- MECHANICAL PERMIT FEES” Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) � : Plan review(25%of permit fee) ( ) State surcharge(12%of permit fee) CCB lic.: 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: • Fee methodology set by Tri-County Building Industry Service Board, Print name: ,,gryfAr y A 2 1M 1 Date: "6/L25f 13 I:\Building\PermitsVMEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/WEB) 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$50,0.00:00 $347.71 for the first$10,000.00 and $2:54 for each additional$100.00 or • !` fraction thereof,to and including I $50,000.00. ?. i1 ,- $50,000.01 to$l00000.00 $1,363.71 for the first$50,000.00 and .`,, $2:49 for each additional$100.00 or • • 3 fraction thereof,to and including , $100,000.00. 5 . $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. r-, '1 1 - •r: . .. i t �1 t y, • _ yC _ • 1 F • C '1 I_:\Building Permits MEC_PennitApp_040113.doc 2 1 Plumbing Permit Application Building Fixtures CEWE+D FOR OFFICE USE ONLY Received o 2 ��/y, 2 Q City of Tigard Date/By: p al r l J (! t��,-) Permit No.: H5T�I -6)6//7 11111 to 13125 SW Hall Blvd.,Tigard,OR 97223 ,� 2 g 7013 Plan Review • C Phone: 503.718.2439 Fax: 503.598.1960 A�.' Other Permit No.: Plan Review T I G A R D Inspection Line: 503.639.4175 Tin� Date Ready/By: Juris' HI See Page 2 for CITY Internet: www.tigard-or.gov Y 0 F NISIDN Not Supplemental Information TYPE OF WORIBUILDING ) J 1" FEE* SCHEDULE • ❑Nw.,eonstruction ❑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(l)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: Y6 3Q 5,(4, 6reevr�WQ(J time_ Catch basin or area drain 18.76 City/State/ZIP: j Drywell,leach line,or trench drain 18.76 Y Gr/pl/c!L �� `i•71 L4• Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: o I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: ' f 1 all 4 2,1 V A, Manholes 18.76 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 • DESCRIPTION OF WORK Backwater valve 12.51 (I Clothes washer 25.02 Modl+�4\ fi- k.,-4e-t ' Dishwasher / 25.02 Drinking fountain 25.02 • Ejectors/sump 25.02 PROPERTY OWNER I ❑ TENANT • Expansion tank 12.51• Fixture/sewer cap 25.02 Name: eg,r�•ia fy iNZ1ti,C1 Floor drain/floor sulk/hub 25.02 Address: !! '''�J/ 1(%/ GJ I..f 4/'Ge,ki t 41' �.a,1,tL D(�f4 `7 Garbage disposal I 25.02 City/State/ZIP: ! `�Gi'✓ o(�- ''7ZZ4- Hose bib 25.02 Phone:(rj'p3) I'OL+-/_con1 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 12.51 E-mail: Urinal 25.02 Water closet ') 25.02 CONTRACTOR - Water heater 37.52 Business name: 0(4/ t Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: .-11: TOTAL PERMIT FEE Print name: Date: �1 13 This permit application expires if a permit is not obtained within 180 days rylvvrar 2. 2l M t / after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. • •/ 1:\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-151100' 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 Storm&Rain Drain-1st 100' 62.54 'Valuation: Permit Fee: $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.Ins 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 Stall as defined in OAR918-780-0040. CI Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial CI Any multipurpose fire sprinkler system. Domestic CI 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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Electrical Permit Application i FOR OFFICE USE ONLY RECEIVED Received (/ q (� / I 7J1 Permit No.: �5i �3-dQ��7 114 City of Tigard Date/By: Tj s 0 Y 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' C ' Phone: 503.718.2439 Fax: 503.598.19 DateB : Other Permit: I!f, 2 S _"t3 y p Ready/By: ® See Page 2 for T I Ci A R u Inspection Line: 503.639.4175 Date Read B : 3uris: Internet: www.tigard-or.gov CITY OFTIGABD Notified/Method: Supplemental Information TYPE OF PLAN REVIEW _ R��INla D IVISION ❑New construction Please check all that apply(submit 2 sets of plans w/items checked below): (1Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition El 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 and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. El Multi-family El 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: '4 3 0 5 t W Six or or more. occupancy. fp s�lt/q �K. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: °�`, /� G� ❑Health-care facilities. ❑Supply voltage for more than ty t T Q� `` `�2 2 ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. I+ Q FEE SCHEDULE Cross street/directions to job site: t441) f? )/<1, Description _J Qty. I _Fee. Total I • LLL New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) r Limited energy,multi-family 75.00 2 N 1744 /44 aot ; 17 4 , ��c k�,H, residential(with above sq.ft.) / 17 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation LIYPROPERTY OWNER ❑ TENANT • 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: Q,o to r / Z 1/�. �/ A; l 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 �113� ..,�. G�feeMs Wu✓� Le(K.� � Over 1,000 amps or volts 552.26 2 City/State/ZIP: f `�A/ �� -)t 7 2L Temporary services or feeders installation,alteration,and/or Phone:(503) , 71.1-__ c(4"A Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation i being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exc ,.• _e according to ORS 447,449,670,and 701. —,� 401 amps to 599 amps 168.54 2 Owner signature: _,tj Date: Z Branch circuits–new,alteration,or extension,per panel ❑ APP C• ❑•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 l Contact name: service or feeder fee,first branch circuit 56.18 2 Address: Each add''branch circuit 7 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: Cr)CC 10((L' Signal circuit(s)or limited-energy See panel,alteration,or extension. _ Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP: Investigation(I 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 Lie.: Suprv.Lic.: specifically listed(V2 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: 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. • Number of inspections allowed per permit. 1:t Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/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 Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I • Renewable electrical energy systems: Check Typ f 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 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 El 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 El Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ElOther: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr Inspections for which no fee is 90.00/hr specifically listed(%z 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 ElAudio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. El Boiler Controls El Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC El Instrumentation El 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 t:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 v 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 ISI 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. Tarckvvt.4 rZ 32ct+^ A24 toVN Print Name of Pe it Applicant ,......• di l‘i 2-etq l 1 gnatu(of Permit Applicant Date Permit#: t J oho l -2D—00 I T? X10 30 u �e,t� ` ∎4, Address: �� .�n ..� Issued by: Date: (1 This Copy for Permit Offices Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 8630 SW GREENSWARD LN, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal 2014-01-03 (null) MST2013-00197 PASS Violation Summary: Inspector Contractor CITY OF TIGARD MASTER PERMIT I s : COMMUNITY DEVELOPMENT Permit#: MST2013-00197 T LGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2013 Parcel: 2S111AA02700 Jurisdiction: Tigard Site address: 8630 SW GREENSWARD LN Subdivision: GREENSWARD PARK Lot: 11 Project: Azimi Project Description: Interior remodel: cover existing atrium and relocate kitchen 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: $30,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 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: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 8 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: DINDAR-AZIMI,FARAMARZ AND RASH! OWNER Required Items and Reports(Conditions) 18520 DELENKA LN LAKE OSWEGO,OR 97034 PHONE: 503-804-8481 PHONE: FAX: Total Fees: $1,474.36 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 Notification Center. T.ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain - •• •r direct questions to OUNC by calling 503.232.1987 or 1 :00.332.2344. Issued B �� Permittee Signature: ...Agar/ r.11 "c_''5 by 7:00 a.m.for the next available inspection Pr This permit card shall be kept in a conspicuous place on the job site until • etion o'the project. Approved plans are required on the job site at the time of eac Inspectlo Building Permit Application Residential Foli.orFlcF. use ONLY T , City of Tigard RECEIVED Date/B : Ct �0 Permit • No.: 3rg )/3-od/7 2 ° 13125 SW Hall Blvd.,Tigard,OR 972 3 `' Plan Review , C.- Phone: 503.718.2439 Fax: 503.598. 6 L g n DateB : m��A Other Permit: 2 .J 13 lung: ® See Page 2 for T I G n R D Inspection Line: 503.639.4175 Date ReadyBy, g Internet: www.tigard-or.gov CITYOFTIG Notified/Method:Ready y /I? Supplemental Information BUILDI DNIS p1V d -{zr ''i•rye.,7' TYPE OF WO 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. 12K-and 2-family dwelling ❑Commercial/industrial Valuation: amp oa El Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION II Total number of floors: Job site address: '6'6 3Q ' .k), Gf eQvtco t(d Let ntie_ New dwelling area: square feet City/State/ZIP: 1-14/./. d p p 413221- Garage/carport area: square feet Suite/bldg./apt.no.: ((JJ Project name: Covered porch area square feet Cross street/directions to job site: q1/ b,v� Deck area: square feet Other structure area: square feet REQUIRED DATA:'COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the n - ' DESCRIPTION OF WORK work indicated on this application. C6ver a v. e X fi, Miff;J/w.. 'TO PloJ� it-7 Valuation: S k,4 ```( Existing building area square feet l..,,t ever, New building area: square feet lir PROPERTY OWNER ,❑ TENANT • - Number of stones: Name: 7 (t yvtelt/'Z Z I Al 1 Type of construction: Address: gj'(Q 0 � i,J , al/e�:v 3 Wa (d. (a t1 Q. Occupancy groups: City/State/ZIP: C dd jQ 4.72 [ Existing: Phone:(503) Jq. V-f••S'( 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: Total fees due upon application: City/State/ZIP: Amount received: c , s Phone:( . ) Fax: :( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* • Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: Q Cl.) 1 ) (72 Submit two(2)sets of roof plan with connect••• •etails and fire des:.• ent access,along wi • e 010 Oregon Address: Solar Installation , 'al _..e checklist. City/State/ZIP: Permit -: • c ude . • review $180.00 an. as inistrative - Phone:( ) Fax:( ) o State surcharge(12%of permit fee): $21.60 CCB lie.: i Total fee due upon application: $201.60 Authorized signature. �J This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ,!", TZ)M Date: L� *Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) 1 .. Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE.USE ONLY • City of Tigard Received Permit No.: II a 13125 SW Hall Blvd.,Tigard,OR 97223 Date .y. ': 13 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical I G A R D 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. ❑ ❑ El 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El 6 Sewer permit. ❑ _ CI ❑ 7 Water district approval. ❑ El 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- El El ❑ 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. I 1 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 ❑ El ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El El ❑ 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- El ❑ El 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. ❑ El ❑ 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 El ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered El ❑ El 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. El ❑ El 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ El ❑ 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 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 for Item 11 above. Site plans must be 8-1/2"x II"or 11"x 17". ❑ El ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. El ❑ El 25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ El ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ El ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. El El ❑ 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, ❑ El ❑ 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) Mechanical Permit A lic FOR OFFICE USE ONLY 1,1 City of Tigard Date/By:13125 �, 4 7 C ° 13125 SW Hall Blvd.,Tigard,OR 97223 IdQ� 8 EIVEh Plan Review Phone: 503.718.2439 Fax: 503.598. ' 2 2013 Received � Date/By: Permit No.: Other Permit: T I G A It D Inspection Line: 503.639.4175 Date Ready/By: luris ® See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD 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 1:1 ❑New construction Ad dition/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 ❑CommerciaUindustrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: '(e c7 ` ./ cfe....evt 5 (,(far d if __ Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-714i d '� 72 Z[{ 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: /4 // 61v' . Hydronic hot water system 23.32 of 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert I 33.39 /'+� � Flue vent for water heater or gas l-aver cr+1 AV4-e;IJrwt gam, sf,„ ,z_ 7 /4C1,,, 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: toff-0'w a r z_ A Z1,� Range hood/other kitchen equipment / 33.39 Address: r 3O ,I„J , r,cQ,,,vS W a s'c Lc ,.t,L_ Clothes dryer exhaust 33.39 City/State/ZIP: 7-7113t/Q t� .17 ZZc- Single-duct exhaust(bathrooms, 2 I toilet compartments,utility rooms) --.7 23.32 Phone:(503) ip:,Gf_ ZLt--'1 Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel pi Business name: $\ 14 115 first four;$4.03 for each additional Contact name: Fumace,etc. _ _ _ Gas heat pump — - Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax: :( ) Fireplace I Range E-mail: Barbecue ./ .__ CONTRACTOR Clothes dryer(gas) . Other: Business name: OWP,--,r- MECHANICAL PERMIT FEES” Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) � : Plan review(25%of permit fee) ( ) State surcharge(12%of permit fee) CCB lic.: 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: • Fee methodology set by Tri-County Building Industry Service Board, Print name: ,,gryfAr y A 2 1M 1 Date: "6/L25f 13 I:\Building\PermitsVMEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/WEB) 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$50,0.00:00 $347.71 for the first$10,000.00 and $2:54 for each additional$100.00 or • !` fraction thereof,to and including I $50,000.00. ?. i1 ,- $50,000.01 to$l00000.00 $1,363.71 for the first$50,000.00 and .`,, $2:49 for each additional$100.00 or • • 3 fraction thereof,to and including , $100,000.00. 5 . $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. r-, '1 1 - •r: . .. i t �1 t y, • _ yC _ • 1 F • C '1 I_:\Building Permits MEC_PennitApp_040113.doc 2 1 Plumbing Permit Application Building Fixtures CEWE+D FOR OFFICE USE ONLY Received o 2 ��/y, 2 Q City of Tigard Date/By: p al r l J (! t��,-) Permit No.: H5T�I -6)6//7 11111 to 13125 SW Hall Blvd.,Tigard,OR 97223 ,� 2 g 7013 Plan Review • C Phone: 503.718.2439 Fax: 503.598.1960 A�.' Other Permit No.: Plan Review T I G A R D Inspection Line: 503.639.4175 Tin� Date Ready/By: Juris' HI See Page 2 for CITY Internet: www.tigard-or.gov Y 0 F NISIDN Not Supplemental Information TYPE OF WORIBUILDING ) J 1" FEE* SCHEDULE • ❑Nw.,eonstruction ❑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(l)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: Y6 3Q 5,(4, 6reevr�WQ(J time_ Catch basin or area drain 18.76 City/State/ZIP: j Drywell,leach line,or trench drain 18.76 Y Gr/pl/c!L �� `i•71 L4• Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: o I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: ' f 1 all 4 2,1 V A, Manholes 18.76 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 • DESCRIPTION OF WORK Backwater valve 12.51 (I Clothes washer 25.02 Modl+�4\ fi- k.,-4e-t ' Dishwasher / 25.02 Drinking fountain 25.02 • Ejectors/sump 25.02 PROPERTY OWNER I ❑ TENANT • Expansion tank 12.51• Fixture/sewer cap 25.02 Name: eg,r�•ia fy iNZ1ti,C1 Floor drain/floor sulk/hub 25.02 Address: !! '''�J/ 1(%/ GJ I..f 4/'Ge,ki t 41' �.a,1,tL D(�f4 `7 Garbage disposal I 25.02 City/State/ZIP: ! `�Gi'✓ o(�- ''7ZZ4- Hose bib 25.02 Phone:(rj'p3) I'OL+-/_con1 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 12.51 E-mail: Urinal 25.02 Water closet ') 25.02 CONTRACTOR - Water heater 37.52 Business name: 0(4/ t Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: .-11: TOTAL PERMIT FEE Print name: Date: �1 13 This permit application expires if a permit is not obtained within 180 days rylvvrar 2. 2l M t / after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. • •/ 1:\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-151100' 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 Storm&Rain Drain-1st 100' 62.54 'Valuation: Permit Fee: $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.Ins 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 Stall as defined in OAR918-780-0040. CI Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial CI Any multipurpose fire sprinkler system. Domestic CI 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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Electrical Permit Application i FOR OFFICE USE ONLY RECEIVED Received (/ q (� / I 7J1 Permit No.: �5i �3-dQ��7 114 City of Tigard Date/By: Tj s 0 Y 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' C ' Phone: 503.718.2439 Fax: 503.598.19 DateB : Other Permit: I!f, 2 S _"t3 y p Ready/By: ® See Page 2 for T I Ci A R u Inspection Line: 503.639.4175 Date Read B : 3uris: Internet: www.tigard-or.gov CITY OFTIGABD Notified/Method: Supplemental Information TYPE OF PLAN REVIEW _ R��INla D IVISION ❑New construction Please check all that apply(submit 2 sets of plans w/items checked below): (1Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition El 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 and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. El Multi-family El 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: '4 3 0 5 t W Six or or more. occupancy. fp s�lt/q �K. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: °�`, /� G� ❑Health-care facilities. ❑Supply voltage for more than ty t T Q� `` `�2 2 ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. I+ Q FEE SCHEDULE Cross street/directions to job site: t441) f? )/<1, Description _J Qty. I _Fee. Total I • LLL New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) r Limited energy,multi-family 75.00 2 N 1744 /44 aot ; 17 4 , ��c k�,H, residential(with above sq.ft.) / 17 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation LIYPROPERTY OWNER ❑ TENANT • 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: Q,o to r / Z 1/�. �/ A; l 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 �113� ..,�. G�feeMs Wu✓� Le(K.� � Over 1,000 amps or volts 552.26 2 City/State/ZIP: f `�A/ �� -)t 7 2L Temporary services or feeders installation,alteration,and/or Phone:(503) , 71.1-__ c(4"A Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation i being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exc ,.• _e according to ORS 447,449,670,and 701. —,� 401 amps to 599 amps 168.54 2 Owner signature: _,tj Date: Z Branch circuits–new,alteration,or extension,per panel ❑ APP C• ❑•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 l Contact name: service or feeder fee,first branch circuit 56.18 2 Address: Each add''branch circuit 7 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: Cr)CC 10((L' Signal circuit(s)or limited-energy See panel,alteration,or extension. _ Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP: Investigation(I 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 Lie.: Suprv.Lic.: specifically listed(V2 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: 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. • Number of inspections allowed per permit. 1:t Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/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 Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I • Renewable electrical energy systems: Check Typ f 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 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 El 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 El Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ElOther: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr Inspections for which no fee is 90.00/hr specifically listed(%z 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 ElAudio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. El Boiler Controls El Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC El Instrumentation El 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 t:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 v 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 ISI 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. Tarckvvt.4 rZ 32ct+^ A24 toVN Print Name of Pe it Applicant ,......• di l‘i 2-etq l 1 gnatu(of Permit Applicant Date Permit#: t J oho l -2D—00 I T? X10 30 u �e,t� ` ∎4, Address: �� .�n ..� Issued by: Date: (1 This Copy for Permit Offices