Permit a
CITY OF TIGARD MASTER PERMIT
ill s ' COMMUNITY DEVELOPMENT �� Permit#: MST2013 00211
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503 718 2439 Date Issued: 10/10/2013
Parcel: 2S103DB08200
Jurisdiction: Tigard
Site address: 11170 SW MORGEN CT
Subdivision: GENESIS NO 3 Lot: 93
Project: Hier
Project Description: Replace existing bearing wall with beam and (1) new footing. 3/13/14, reprinted to add range
hood and register. - - —
BUILDING
Floor Areas Required Setbacks Required
Stories. 0 Bedrooms: 0 First 0 sf Basement 0 s1 Left 0 Parking Spaces 0
Height 0 Bathrooms. 0 Second 0 sf Garage 0 sI Front 0 Smoke
Dwelling Units 0 Third 0 sf Right 0 Detectors
Total 0 sf Value $2.500 00 Rear 0
PLUMBING
Sinks: 0 Water Closets 0 Washing Mach 0 Laundry Trays. 0 Rain Drain 0 Urinals 0
Lavatories. 0 Dishwashers 0 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0
Tubs/Showers 0 Garbage Disp 0 Water Heaters 0 Water Lines 0 Drains 0 Catch Basins 0
Bckftw Prevntr 0
Footing Drain 0 Ice Make'. 0 Hose Bib 0 Backwater Value. 0
Drywall-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 1
Furn<100K. 0 Vents 0 Woodstoves. 0 Gas Outlets 0
Furn>=100K 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less 0 0-200 amp 0 0-200 amp 0 W/Svc or Fdr 0
Ea adds 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
Other N Other Descnption Ecompasing N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF V l3 R-3 0
Owner: Contractor:
HIER FAMILY TRUST CORNERSTONE BUILDERS INC Required Items and Reports(Conditions)
BY JAMES D&RENETTA A HIER 7849 SW CIRRUS DR
TRS BEAVERTON,OR 97008
11170 SW MORGEN CT
TIGARD,OR 97223
PHONE PHONE 503-671-9538
FAX 503-671-9640
Total Fees: $319.51
This permit is issued subject to the regulations contained in the Tigard Municipal Code State of OR Specialty Codes and all other applicable law All work will
be don actor 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 rules .are set forth in OAR
95 001-0010 through OAR 952 N090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 1 e 2344
Issu By: je\ _ "`�`�"`mob 1%_e Permittee Signature: X r
_ 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.
CITY OF TIGARD MASTER PERMIT
NI ' COMMUNITY DEVELOPMENT Permit#: MST2013-00211
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 2S103DB08200
Jurisdiction: Tigard
Site address: 11170 SW MORGEN CT
Subdivision: GENESIS NO.3 Lot: 93
Project: Hier
Project Description: Replace existing bearing wall with beam and(1)new footing
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:
Total: 0 sf Value: $2,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 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: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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
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:
HIER FAMILY TRUST CORNERSTONE BUILDERS INC Required Items and Reports(Conditions)
BY JAMES D&RENETTA A HIER 7849 SW CIRRUS DR
TRS BEAVERTON,OR 97008
11170 SW MORGEN CT
TIGARD,OR 97223
PHONE: PHONE: 503-671-9538
FAX: 503-671-9640
Total Fees: $218.71
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through••- 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or .2344.
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received 1 3 /y ��� Permit x, ,^-{5 f �j ��GY�a.I/,
;. . •• 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review• Phone: 503.718.2439 Fax: 503.598.1960
71
Date/By: Other Permit:
TI G A R 1 Inspection Line: 503.639.4175 Date Ready/By: mr;s 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑ Master builder ❑Other: Description I Qty. J Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11,1 0 S(ni vyNc, t ti c l - Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 77 Ov.. • 17`Z- 2-3 Furnace 100,000+BTU(ducts/vents) 54.91
V- / Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work ( 23.32 a j
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,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 33.39
Flue vent for water heater or gas
(yt ( /74416 g 1i3, / Yf4a-004M- F /cam fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
6-r Vii' % j 7T )/ j- ) // Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 1. 33.39 35 3?
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: S14.1S for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
WalUsuspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range .
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)/ Other:
Business name: be.ly ow S � S N!C-
�°� �t'+'1 I MECHANICAL PERMIT FEES*
Address: "11 Y9 S W cirt-A-iS "Pit• Subtotal 17-3?
City/State/ZIP: a Ve'l'Tg,!'1 cht- 9 Toe 7 Minimum permit fee($90.00) (),t30
/ Plan review(25%of permit fee)
Phone:(5P3)G7!_ 37 Fax:(s•3) G7 r- 9e yo State surcharge(12%of permit fee) /p,g-d
CCB lie.: /70 6s)' TOTAL PERMIT FEE /V, "p
This permit application expires if a permit is not obtained within 180
1...% t✓ / days after it has been accepted as complete Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: ioe,,/ 7i/mks Date: 3//i 11 y
I.1BuildingTermit s\MEC_PermitApp_040113.doc 440.4617f(11/02JCOM/WWEB)
Building Permit Application
City of Tigard '' Received Q 2 Permit No.: pe0 Q'DO l
•J g �±� Date/By: 7 S A� J �J /
° 13125 SW Hall Blvd.,Tigard,OR 97223 -�ry�1�j-IJ Date/By: W "Io 7 I Other Permit:
Phone: 503.718.2439 Fax: 503.598.1 :i,i La y:
Inspection Line: 503.639.4175 1 Date Ready runs: ® See Page 2 for
1'I G A R D Notified/Method: // Supplemental Information
Internet: www.tigard-or.gov . �, 3 X013 `o��! PP
VNIA7v /
TYPE OF WORDY OFTlG AV„N REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 1p1lt� D'v�s Permit fees*are based on the value of the work performed.
iV'" Indicate the value(rotnded 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: $ Z- o
el-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: (/f7o s ti iv‘,4.(ti6,to -r, New dwelling area: square feet
City/State/ZIP: 7/(r'hap ,ion - Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: /AL-7'2 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. -
/tt�
AC-P(41-CE frivSr/NG ar74w1NG 1.-r{')/ /„///M- gp401-yyl Valuation: $
4kp (f) NE1A/ /bbn�/ Existing building area square feet
(' New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: N I eG(2_, Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
%APPLICANT ❑ CONTACT PERSON NOTICE
Business name: eo p (-04.5 ti'Iie gc.../..} ./ut. , All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lbensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail: — -
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule1
Business name: ('p 9.41 ell,sr-one 8u,ybtNS yL¢ , Permit fee:
Address: 7$r9 S W GYWu j T42.••
State surcharge(12%of permit fee):
City/State/ZIP: 4 L7}1/L l- ..f•r) , cr2 . 9700$ FLS plan review(40%ofpermit fee):
Phone:(sa3 ) (,7/_iv-7 g Fax:(61:23) t 7/_7(y 0 (Due upon application.)
CCB lic.: I70 G Sy 4 f tAo / / Total permit fees:
Authorized signature:# Amount received: '�7 �j This permit application expires if a permit is not obtained
Print name:/�/ ,—v 7 i f//�h5 aty Date: Vz,.....r/3 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\FPS-PermilApp,doc Rev 01/05/2012 440-4613T(11/02/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$50,000.00 $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_0401 I3.doc 2
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Mann
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
_ 3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
Fire Protection Permit Fees _
Project valuation subtotal (see A,B&C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\Building\Permits\FPS-PemmitApp.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11170 SW MORGEN CT, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
April 30, 2014 at 9:02:58 AM
MST2013-00211
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11170 SW MORGEN CT, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
April 30, 2014 at 9:01:12 AM
MST2013-00211
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11170 SW MORGEN CT, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
PASS
April 30, 2014 at 9:02:17 AM
MST2013-00211
Jeff Grove
Violation Summary:
Inspector Contractor
CITY OF TIGARD MASTER PERMIT
NI ' COMMUNITY DEVELOPMENT Permit#: MST2013-00211
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 2S103DB08200
Jurisdiction: Tigard
Site address: 11170 SW MORGEN CT
Subdivision: GENESIS NO.3 Lot: 93
Project: Hier
Project Description: Replace existing bearing wall with beam and(1)new footing
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:
Total: 0 sf Value: $2,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 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: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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
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:
HIER FAMILY TRUST CORNERSTONE BUILDERS INC Required Items and Reports(Conditions)
BY JAMES D&RENETTA A HIER 7849 SW CIRRUS DR
TRS BEAVERTON,OR 97008
11170 SW MORGEN CT
TIGARD,OR 97223
PHONE: PHONE: 503-671-9538
FAX: 503-671-9640
Total Fees: $218.71
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 rules are set forth in OAR
952-001-0010 through••- 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or .2344.
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
City of Tigard '' Received Q 2 Permit No.: pe0 Q'DO l
•J g �±� Date/By: 7 S A� J �J /
° 13125 SW Hall Blvd.,Tigard,OR 97223 -�ry�1�j-IJ Date/By: W "Io 7 I Other Permit:
Phone: 503.718.2439 Fax: 503.598.1 :i,i La y:
Inspection Line: 503.639.4175 1 Date Ready runs: ® See Page 2 for
1'I G A R D Notified/Method: // Supplemental Information
Internet: www.tigard-or.gov . �, 3 X013 `o��! PP
VNIA7v /
TYPE OF WORDY OFTlG AV„N REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 1p1lt� D'v�s Permit fees*are based on the value of the work performed.
iV'" Indicate the value(rotnded 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: $ Z- o
el-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: (/f7o s ti iv‘,4.(ti6,to -r, New dwelling area: square feet
City/State/ZIP: 7/(r'hap ,ion - Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: /AL-7'2 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. -
/tt�
AC-P(41-CE frivSr/NG ar74w1NG 1.-r{')/ /„///M- gp401-yyl Valuation: $
4kp (f) NE1A/ /bbn�/ Existing building area square feet
(' New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: N I eG(2_, Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
%APPLICANT ❑ CONTACT PERSON NOTICE
Business name: eo p (-04.5 ti'Iie gc.../..} ./ut. , All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lbensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail: — -
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule1
Business name: ('p 9.41 ell,sr-one 8u,ybtNS yL¢ , Permit fee:
Address: 7$r9 S W GYWu j T42.••
State surcharge(12%of permit fee):
City/State/ZIP: 4 L7}1/L l- ..f•r) , cr2 . 9700$ FLS plan review(40%ofpermit fee):
Phone:(sa3 ) (,7/_iv-7 g Fax:(61:23) t 7/_7(y 0 (Due upon application.)
CCB lic.: I70 G Sy 4 f tAo / / Total permit fees:
Authorized signature:# Amount received: '�7 �j This permit application expires if a permit is not obtained
Print name:/�/ ,—v 7 i f//�h5 aty Date: Vz,.....r/3 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\FPS-PermilApp,doc Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Mann
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
_ 3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
Fire Protection Permit Fees _
Project valuation subtotal (see A,B&C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
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