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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2014-00048 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2014 Parcel: 2S112BC11000 Jurisdiction: Tigard Site address: 8247 SW MATTHEW PARK ST Subdivision: MATTHEW PARK Lot: 7 Project: Griebel ARU Project Description: 708 sq. ft.accessory dwelling unit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 708 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 2 Third: 0 sf Right: 0 Detectors' Yes Total: 708 sf Value: $78,085.32 Rear 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr 10 Ea add/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: ADU SF VB R-3 708 Owner: Contractor: GRIEBEL,RICHARD J HEARTWOOD BUILDERS Required Items and Reports(Conditions) BROWN,MARJORIE V PO BOX 424 8247 SW MATTHEW PARK ST BANKS,OR 97106 TIGARD,OR 97224 PHONE: PHONE: 541-280-0306 FAX: Total Fees: $3,363.99 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain- - e rules or direct questions to OUNC by calling 503.232.1987• .800.332.234 o if _� /;ii% Issued By: Permittee Signature: �� C 4175 by 7:00 a.m.for the next available inspection �- This permit card shall be ept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Bu:dine Permit Application ' Residential FOR OFFICE USE ONLY Received City of Tigard �� ;' Permit No.: - DateB . 13125 SW Hall Blvd.,Tigard,OR 972231 Plan Revi 'f ` Other Permit: Phone: 503.718.2439 Fax: 503.598.19 Date/I3 : ..,Ii - a I I i, `i.i, Inspection Line: 503.639.4175 �0,4 Date ReadyBy: V tar» % See Page 1 for Internet: www.tigard-or.gov 9 Notift d/Method: 7 98 1y 7�%(f Supplemental Information TYPE OF WORK O. NI510 REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demoliatf l 0) J Permit fees*are based on the value of the work performed. 1ti� Indicate the value(rounded to the nearest dollar)of all �Addi tion/alteration/replacement ❑Othet � equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this ap�plyicatioLna. pI-and 2-family dwelling ❑Commercial/industrial Valuation: ?�j)(� j�'$ ' 1 ` ' 1 Number of bedrooms: ) ❑Accessory building ❑Multi-family Z El Master builder ❑Other: Number of bathrooms: I JOB SITE INFORMATION AND LOCATION Total number of floors: I Job site address: 4E3217 17 -.5`v A, Mo e. 'PC1rk St New dwelling area: 700 square feet City/State/ZIP: 'r3cird.' v(` 9!L i-�' Garage/carport area: square feet Suite/bldg./apt.no.: J I Project name: Grie/b4 AP Covered porch area square feet Cross street/directions to job site: 81 Ave. Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK l work indicated on this application. Ate( q rox.imc{'e.� 70S 5f `IO ey is ini Valuation: $ 51 N5k -f�wul. reoi k'tc- . �e AO, U J Existing building area square feet 7 New building area: square feet ❑ PROPERTY OWNER I ❑ TENANT Number of stories: Name: •KichQrd CGrie ei urjorif-1')rown Type of construction: Address: BL '7 3W Ma�' .i fork Cwt Occupancy groups: City/State/ZIP: II clot rd ofz_ '7z2.1 Existing: Phone:('503) 99 -5.0(. Fax:( ) New: S APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: ��J rwood 154j I der5 vi ewfee�(or deposit): osit):le) Structural plan review fee(or deposit): Contact name: SGDtt" 'Kpq,erg Address: [ 0 rO� -4.z-4 FLS plan review fee(if applicable): City/State/ZIP: QRT� OR 7/0 e Total fees due upon application ,/6.5-1 Phone:(5i( ) ��o-03C�CP Fax::( ) Amount received: E-mail: .51-n c.vciYro9 er5 (�mgll,CO r� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* -J t Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:,e ff4 wQoc ' td,�re Submit two(2)sets of roof plan with connection details 1"" and fire department access,along with the 2010 Oregon Address: 'PQ -BOX 1-Z1 Solar Installation Specialty Code checklist. City/State/ZIP: YahKS OR OR // /04e�U(Q Permit Fee(includes plan review $I80 00 �i,�� and administrative fees): Phone:Mt ) ZDp-O3 uCA Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 1 05`•2.0 h/lo i Total du uppication: $201.60 Authorized signature: /4111/ This permit applifee cation e pon expires a if a permit is not obtained ! within 180 days after it has been accepted as complete. /i ..^ *Fee methodology set by Tri-County Building Industry Print name: �. .erC) Date: .11b Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist • One- and Two-Family Dwelling FOR OFFICE USE ONLY City of Tigard Received 114 . • 13125 SW Hall Blvd.,Tigard,OR 97223 g Phone: 503.718.2439 Fax: 503.598.1960 'permits: I Ii.. ARI) 24-Hour Inspection Line: 503.639.4175 13 Electrical ❑ Plumbing ❑ Mechanical Internet www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑ Verification of approved plat/lot. ❑ ❑ ❑ I Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 _Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore_on and shall be shown to be .••licable to the sro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item II above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ _ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. _ 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. _ I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB) Plumbing Permit Application Building Fixtures CO I OK OI I l( I I ,I ()NI \ Received City of Tigard VS)` PermitNo.: ■ 13125 SW Hall Blvd.,Tigard,OR 97 DateBy: 11111 I Plan Review Phone: 503.718.2439 Fax: 503.5960 �4 Other Permit No.: DateBy: I WARD Inspection Line: 503.639.4175 P �� Date Ready/By: )uric H See Page 2 for Internet: www.tigard-or.gov a �!,A� Notified/Method: Supplemental Information TYPE OF WORK d r(°�aT1G+�"�Jwt►1 FEE* SCHEDULE ❑New construction ❑DetitoEft G In/. " For s,ecial in ormation use checklist r� ❑ IL�I� Description Qty. Ea. Total yr Addition/alteration/replacement New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 gi m 1-and 2-family dwelling ❑Comercial/industrial SFR(2)bath 437.78 building SFR(3)bath 500.32 ❑Accesso ry g ❑Multi-family Each additional bath/kitchen 25.02 El Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: cy4-7 �`, , Nt ,( ew-Rol( '1. Catch basin or area drain 18.76 Job site address: O / V,/ lT i((Tl `�I . Drywell,leach line,or trench drain 18.76 City/State/ZIP: T�aV/ r7Lz� ( ! Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Ci rl t, ` Manufactured home utilities 50.03 Cross street/directions to job site: 01% - 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 Clothes washer , 25.02 Addl:Flini 70t3 J Dishwasher ' 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Ric41q►/c4 GY l f q (Q�.L' Dim Fixture/sewer cap 25.02 �8t r l 5W' M`q( 1t// ark Garbage drain/floor disposal siric/hub 25.02 Address: - Garbage disposal 25.02 City/State/ZIP: QVc 77/4/ Hose bib 25.02 Phone:(5C) ) •• 4 Fax:( ) Ice maker 12.51 ❑ APPLICANT T ❑ 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 2.■ 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet it 25.02 , Water heater 37.52 Business name: G/e i a W 197(t t )'/up-7.1),.7", ,a C . Water piping/DWV 56.29 Address:1/7(T SE . 0/57 s Other: 25.02 City/State/ZIP: / j,, J-fS AT e J 0,e ,9 72 6 6 Subtotal Phone:c5-613) 735 ©f/S Fax: 03) 7e,/ giy3 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic./g0 73 , Plumbing Lic.no.: pe .s"y State surcharge(12%of permit fee) Authorized signature:'/ TOTAL PERMIT FEE �`4,� �-' y��v Date: /�/ This permit application expires if a permit is not obtained within ISO days Print name: r/ p�,�/ / 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-151 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: • Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Ins ections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to I� 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 Jinimum 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Mechanical Permit Application IY)It OI•I I( I. 1 SI. t)\1.1 City of Tigard Date/By: Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 97223 `1 • Received Phone: 503.718.2439 Fax: 503.598.1960 V�� Plan Review Other Permit: Date/By: r I ci A It 1) Inspection Line: 503.639.4175 ��jj Ct Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov 1�j]`� Notified/Method: Supplemental Information TYPE OF WOW\\ A o COMMERCIAL FEE* SCHEDULE - USE CHECKLIST `,(;Q►�� Mechanical permit fees*are based on the value of the work ❑New construction ddition/alteration/rtn �,5,� performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: �1� Ni-C o1 a mechanical materials,equipment,labor,overhead,and profit Value:$ CATEGORY OF CON ON RESIDENTIAL EQUIPMENT/SYSTEMS;Sq-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. 1 Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 13447 4 `r^l 1 i_t faoy /J Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: —j c.y 9 I r"` 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: 6 _' _t 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 /70 b F. Aa lid1 .A13(-1 fireplace - 23.32 f , ""lP-G ��1 tl Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: yV tj ow f (.t( k q O y T5YO►,,tn Range hood/other kitchen ` Address: tVti-4r1"tr`1 I• i"� 'Y`1 equipment t 33.39 �2f7 e" 1904 5'', Clothes dryer exhaust _ , 33.39 City/State/ZIP: ,,( Single-duct exhaust(bathrooms, r7J�rt{ toilet compartments,utility rooms) Z 23.32 Phone:( ) ✓ Fax ( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. — Gas heat pump Address: - Wall/suspended/unit heater . City/State/ZIP: Water heater Phone:( ) I Fax::( ) Fireplace Range _ E-mail: Barbecue CONTRACTOR Clothes dryer(gas) . T\9441 Tom' Other: Business name:�Q ,,y►„ • I rs MECHANICAL PERMIT FEES* Address: l�,1 Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: ii-L00% 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: W : r`+1."/,, Date: I:t BuildingWermits\MEC_PermitApp_040113.doe 0-4 7T(I l/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. l:\Building\Permits\MEC_PennitApp_040113.doc 2 Electrical Permit Application 1:O1R 01.1.1( v. I til (I\l.'t City of Tigard �1� Received Permit No.: 13125 SW Hall Blvd.,Tigard,•" ;'s• . Plan Review Phone: 503.718.2439 Fax: 51 . `8.1960 Date/By: Other Permit: Inspection Line: 503.639.4175 9't014 Date Ready/By: Suns: ® See Page 2 for I I \Kr) Notified/Method: Supplemental Information Internet: www.tigard-or.gov APR `_A PP TYPE OF W �rl,�%(Jt'a Q5 � PLAN REVIEW ❑New construction XrAddition/al � IIY`" Please check all that 400 amps(submit sets of plans w/items checked below): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: iii:1- 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 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. /❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address:VZi, / Ain/ aA 5+.. 100HP or more. occupancy. P. t i ekt ❑Six or more residential units. ❑Recreational vehicle parks. • City/State/ZIP: iI CO/ck \ OR Lam,7� ❑Health-care facilities. ❑Supply voltage for more than /I�"�( ' I ❑Hazardous locations, 600 volts nominal. Suite/bldg./apt.no.: Project name: Gtr i't b L AD IA ❑Service or feeder 600 amps or more. rl ��!!! ✓� FEE SCHEDULE Cross street/directions to job site: 0 I% Description I Qty.1 Fee. I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential ` DESCRIPTION OF WORK (with above sq.ft.) 75.00 _ _ 2 Limited energy,multi-family 75.00 2 „ IQh Oil(�- 'Del 5.. . ADU residential(with above sq.ft.) �1 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation _ ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less_ t 100.70 2 201 amps to 400 amps 133.56 2 Name: i J„a,,4 (41/14,1,7 el 1 Mil/(0 rec. �+'2 Cn 401 amps to 600 amps 200.34 2 Address: 02.e{/� L,(,t `(�� `J'I'aI/k 5 f 601 amps to 1,000 amps 301.04 2 `�*7 Over 1,000 amps or volts 552.26 2 City/State/ZIP: /�'r urr( O C72.;ef Temporary services or feeders installation,alteration,and/or Phone:( 7 3) l ei Fax:( ) relocation 7 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,per panel ❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, (© 7.42 2 Business name: each branch circuit B.Fee for branch circuits without Contact name: service or feeder fee,that 56.18 2 branch circuit • Address: Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:( ) Fax: :( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 • CONTRACTOR Signor outline lighting 67.84 2 Business name: C J,(W 714 5 / I C Signal circuit(s)or limited-energy See l G./ panel,alteration,or extension. Page 2 _ 2 Address: 't70 j�77� S37,tk Each additional inspection over allowable in any of the above 1 `'� Additional inspection(1 hr min) 66.25/hr City/State/ZIP: ti_o LUN. 0 R.— C)7 DQ� Investigation(1 hr min) 66.25/hr . _ (�b ) 70 c c sc. 9 ` (') 3 71 3 c) 4,C) Industrial plant(1 hr min) 78.18/hr Phone: Fax: o ) Inspections for which no fee is 90.00/hr CCB Lie.:13‘61 7 3 Electrical Lic.:3q- 710C_ Suprv.Lic.:4633 5 specifically listed CA hr min) _. ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: i/evi n) T. .-�_ 1 Date: g. III Plan review(25% permit fee): (,,.A ►J State surcharge(12/o of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC_PennitApp_ELR_ERE.dac 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 l-Qty. I Fee I Total I Renewable electrical energy systems: Check Type of Work Involved: 5 kvaorless 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 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 ID Heating, Ventilation and Air Conditioning OAR 918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 ElOther: additional inspection over allowable in any of the above: Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(V2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 . a Building Permit Number: A S-;7pi &i.),Thcr INI Building Permit Review Residential Projects I IGARD Site Address: 42 w 41 &Ai Wtiii1 Wad - eth\erify site address is valid. Project Name & Lot #: 4ZleIXA Al2L1. Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/1995) Required: Yes ❑ No ❑ Received: Yes ❑ No ❑ Site Plan Elements: (9 // ite plan must be on 8-1/2"x 11"or 11"x 17"paper 21Iiree(3)copies of site plan Q,�,P��rawn to scale(standard architect or engineer scale) ,,,,__,,� rth arrow L�NIap and tax lot number,site address,project or subdivision L iotprint of new structure(including decks)with finished ne,lot number,and zoning flyor elevations Ly'Applicant information(name and phone number) E . ot..and building setback dimensions roperty corner elevations(2 foot contour lines if more than t area,building coverage area,percentage of coverage and 4 foot differential) impervious area. �tility locations MK/cation of wells/septic systems. C` xisting structures on site aSitrface drainage [ Strtreet names 12150et tree size,type and location EFES:;sion control(including drainage-way protection,silt fence [ Existing trees to be retained with drip line,and tree design,location of catch basin,etc.) protection measures Planning Review I El-rand Use Case Number: IN X _Ul 2 014-CooC) i 11--Zoning: R L 'Setbacks: Front 2) Rear t S Side 5' Street Side N/A Garage 2,p L7 Landscape Requirement: N/A % Lot Coverage Maximum: Nh W-1 uilding Height: Maximum Height 30 Actual Height + C i Vg-suClearance al asements Piensitive Lands: ❑ Yes Type L Jrban Forestry Plan Conditions Satisfied Approved by: kialittA G j Date: 14.9. 1 4 Notes: Revisions (after Building Submittal only) Reviewer Date Revision 1 Approved ❑ Not Approved ❑ Revision 2 Approved ❑ Not Approved ❑ Revision 3 Approved ❑ Not Approved ❑ I:1Building\Forms\BIdgPermitRvw_RES_123013.docx 4 . . • Building Permit Submittal Original Plan Submittal: Date: WY By: .'7 Site Plans: # 3 Building Plans: # Create Case Record#: 0.—Eater case#above or Building Permit Number. Workflow Routing �lE'Plan iirg �eering ICJ-�Pernut Coordinator Ll—>�uilduig Workflow Sign-off: [�- 'off for Planning staff,including notes from planning review(page 1) Route Application Documents: E ngineering: (1)copy of permit application, (1) site plan, (1) building plan and o al plan review routing form. 0*-Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Reviewed By: Date: Notes: Engineering Review—reviewed by: 42 Actual Slope: . 7 ❑ Conditions Satisfied Notes: Approved by: ` ,j / / Date: y— 9_fh Revisions(after Building Submittal only) Reviewer Date Revision 1 Approved X. Not Approved ❑ Revision 2 Approved ❑ Not Approved ❑ Revision 3 Approved ❑ Not Approved ❑ Permit Coordinator Review '=conditions Met-Prior to Issuance of Building Permit Notes: Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Ap• 'cant Revision Notice 3: Date Sent to /1./ Okay to Issue Permit- Date: �.A/ I:\Building\Forms\BldgPermitRvw_RES_123013.docx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 8247 SW MATTHEW PARK ST, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2014-00048 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 8247 SW MATTHEW PARK ST, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2014-00048 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 8247 SW MATTHEW PARK ST, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PART MST2014-00048 Herb Stabenow Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 8247 SW MATTHEW PARK ST, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2014-00048 Herb Stabenow Violation Summary: Inspector Contractor