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Permit II CITY OF TIGARD I MASTER PERMIT COMMUNITY DEVELOPMENT 1 iraire ift Permit#: MST2014-00063 IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/19/2014 T Parcel: 2S109AB07500 Jurisdiction: Tigard Site address: 13055 SW ST JAMES LN Subdivision: RAVEN RIDGE Lot: 4 Project: MEERMEIER Project Description: Crawl space conversion of 505 sq ft to office and wine seller, including foundation and floor framing repairs.Actual square footage was 325. Revised and reprinted 8/14/14 MAV. BUILDING Floor Areas Required Setbacks Required Stones: 0 Bedrooms: 0 First: 0 sf Basement: 325�� 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: 325 / sf Value: $55,696.45 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: 1 Other Fixture Units: 505 sq ft of additional sprinkler coverage MECHANICAL Fuel Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 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 add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr 3 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-3 325 Owner: Contractor: MEERMEIER,PAUL J&NANCY E Required Items and Reports(Conditions) 13055 SW ST JAMES LN TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $2,214.06 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. ATTEN 44. •egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. `Those rules are set forth in OAR 952-001-•• 0 through OA' 95 401-4090. You may obtain a copy of the rules or direct questions to OUNC by Cain/ 1.800.332.2344. Issu•d By: —..g. /�„ /�/ .1 / Permittee Sig lure: _ _ l/'/ Call 503.639.4175 by 7:00 a.m.for the next available inspection da . This permit card shall be kept in a conspicuous place on the job site until com on of the project. Approved plans are required on the job site at the time of each Inspection. CITY OF TIGARD MASTER PERMIT II I. COMMUNITY DEVELOPMENT Permit#: MST2014-00063 Date Issued: 05/19/2014 T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S109AB07500 Jurisdiction: Tigard Site address: 13055 SW ST JAMES LN Subdivision: RAVEN RIDGE Lot: 4 Project: MEERMEIER Project Description: Crawl space conversion of 505 sq ft to office and wine seller, including foundation and floor framing repairs. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 505 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: 505 sf Value: $55,696.45 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 Drywall-Trench Drain: 0 Other Fixtures: 1 Other Fixture Units: 505 sq ft of additional sprinkler coverage MECHANICAL Fuel Topes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 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-3 505 Owner: Contractor: MEERMEIER,PAUL J&NANCY E Required Items and Reports(Conditions) 13055 SW ST JAMES LN TIGARD,OR 97224 PHONE PHONE: FAX: Total Fees: $2,214.06 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 day- o iss - ce, • ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification •-n rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a •• . - or direct questions to OUNC by calling 50 i; 2.2344. l Issued By: PermiRls2 Signature: .' .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 6.4/,(dl--k/ c `1r`j,� FOR OFFI( 1: I SE 0\1.1 vY` Received City of Tigard �C1� Date/8 : „,,,,W, Permit •No.: f1') I., ^r !IN "I 13125 SW Hall Blvd.,Tigard,OR 9722. Plan Re 'e.► Phone: 503.718.2439 Fax: 503.598.1960 Q 014 DateBy.4r v' � 1.., a Other Permit: 1. li 1 Inspection Line: 503.639.4175 p Date Ready :y: �� Juris ® See Page 2 for Internet: www.tlgard or.gov p,PR �p� Note Read ethod: /,_:4� ?_f Supplemental Information TYPE OF WORICI.T��ir li311* �o / REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑D �� Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all FtAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. F.1-and 2-family dwelling _ ❑Commercial/industrial Valuation: $ 2 � ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: ( 30 6 5 S w 51 pom q 5 J New dwelling area f� square feet City/State/ZIP: T cav 0 Z "/722. Garage/carport area: J`''' square feet Suite/bldg./apt.no.: Project name: mFFie a, p.____ \(n Covered porch area square feet Cross street/directions to job site: 4 Deck area: square feet \)1?.‘ Other structure area: square feet emu.- ,lam' �� REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: f� /� t no.:,'(,�1�,a!� Permit fees*are based on the value of the work performed. N 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: $ I P A i 1 2 5 ID h'N ki p,grl 1 5 J F 2 0 D O- G„ Ai' /N e l 0Z C izA w C, 4 NAc 0 IZD OM _Existing building area square feet 1 I /OT ,vezA) ;,,q A Ai, New building area: square feet 0 PROPERTY OWNS ❑ TENANT / glY Number of stories: Name: PqIAL M S 1-I a _t\ Type of construction: Address: i 3 D 54 S W ST TPrrl .5 (..-N-1 Occupancy groups: City/State/ZIP: 1 I ccPnt 0 J _I 72296 /' Existing: Phone:( 0**) 5-0`T-7126 Fax:( t)3) 7 2T ' 6-1 R 0 New: 7 lir APPLICANT 1111 CONTACT PERSON NOTICE Business name: 5 P 5 F iJ L1 11 N(t R 1\4 All contractors and subcontractors are required to be Contact name: A N D,v *rtyM B t-K licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: ( 4-tl W Acs t410 &rbKs ds t jurisdiction in which work is being performed.If the City/State/ZIP: Q R ct-� o t„�S applicant is exempt from licensing,the following reasons C'Z ON CI t11 t pP y: Phone:( y0 3) L4-3 000 Fax::( ) — E-mail: 0( 11 .1 4 e,�h L , k✓` C CPOR BUILDING PERMIT FEES* (Please refer to fee schedhk) Business name, C� 20 �.r Co Permit fee: 11 Address: ,� ©3nc�j-Q State surcharge(12%of permit fee): City/State/ZIP: U(4 1-t,./ •J O b R 9 Val F t : re ew( ■'.of,- it =-): Phone:( ;) q VI - LO t% Fax:( ) • - upo .'plc ,lion. CCB lie.: ?5 (4 7 1 if(all S Total permit fees: Authorized a re Amount received: ' This permit application expires if a permit is not obtained Print name: Date: (.j-„28.- 4 within 180 days after it has been accepted as complete. x. * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permi \FP PermitApp.doc 02/01/2011 440.46131(11/02/COM/WEB) t 7 7 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 El 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 Alarm 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-PermitApp.doc 02/01/2011 2 Mechanical Permit Application � II)K III 111 I l `,1 11\1 1 City of Tigard ��� 777��� Received y/ �� Permit No.: �/ &I-101 i 1111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.598.196 Plan Review S iJ�� DateBy: Other Permit: i i I,I Inspection Line: 503.639.4175 1 ate Ready/By: ® See Page 2 for 9 ady/B Juris Internet: www.tigard-or.gov ,`t�� `=0` 1No ed/Method: 'D---‘ Supplemental Information M f � %"\S S COMMERCIAL FEE*-L SCHEDULE - USE CHECKLIST TYPE OF WORK r_ i``�v� Mechanical permit fees'are based on the value of the work ❑New construction g Addition/alteration/rep�Qt}f performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: w mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 1 365-s— S J iY.€J 4,v Furnace 100,000 BTU(ducts/vents) 46.75 _ City/State/ZIP: --/i _ / U p Cf y Furnace 100,000+BTU(ducts/vents) 54.91 I-�'7 f iL Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 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,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 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 I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: 7\ Name: ?a , I pi PC as^it.s e Range hood/other kitchen equipment _ 33.39 Address: 13 0 s.5 .S G4:1 S/t--Y.- ,r4., ,5. L_f� Clothes dryer exhaust 33.39 - City/State/ZIP: T' La✓, ) r Ci. 1?-.>_,_c.t Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(SQl_) 5-94:7--' -Q 8:::, Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: ti Fuel piping: 4 t C'1,,..-/'i L e r $14.15 for first four;$4.03 for each additional Contact name: J Furnace,etc. Address: 1 3 0.5 � .5 to S ;tit J&rn C-S L Z- Gas/cusp nde Wall/suspended/unit heater City/State/ZIP: T 19 a.�i 0,— 477 2 22 `t Water heater Phone:(503) .5-9 a - 7- 3 g o Fax::( ) Fireplace Range E-mail: J S b v nzUic..1- ham, cpft,h.. Barbecue , CONTRACTOR Clothes dryer(gas) Business name: Other: S�� MECHANICAL PERMIT FEES" Address: Subtotal _ City/State/ZIP: Minimum permit fee($90.00) !0 Phone:( ) �`�_\, Fax:( ) Plan review(25/o of permit fee) State surcharge(12%of permit fee) l p,ij CCB lic.: TOTAL PERMIT FEE /00:TA This permit application expires if a permit is not obtained within 180 `l days after it has been accepted as complete. �/ Authorized Slgnat • Fee methodology set by Tri-County Building Industry Service Board Print name: - �c.„t_1 ?ri eGr y , v--- Date: .3-) )Q f 2 p(c f I:\Building\PermitsVMEC_PermitApp_040113.doc 440-46I7r(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$50,000.00 $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. 1:\Building\Permits\MEC_PermitApp_040I 13.doc 2 Plumbing Permit Application Building Fixtures iVi SO FOR OFFICE, USE ONLY Received City of Tigard Permit No 13125 SW Hall Blvd.,Tigard,OR 972 �Ot�Q Date/By: / /i ( '`'/J r �"ZL c y _,.:A.._46,3 Phone: 503.718.2439 Fax: 503.598.1960 ,9 `Plan By Review Other Permit No.:J •ate/ By: f G A K p Inspection Line: 503.639.4175 0 vN Ready/By: ions ® See Page 2 for Internet: www.tigard-or.gov ,1 G . �, V �`'� fied/Method: �C Supplemental Information TYPE OF WORK �(�Yv*r v FEE* SCHEDULE A` ❑New construction ❑DemoLitly For special information use checklist � �l'_ Description I Qty. I Ea. I Total Igt Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility correction) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 X 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 •❑Accessory building SFR(3)bath 500.32 g ❑Multi-family • Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler 07147-sq.ft.) Page 2 121.96 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: cc T�_,,_ Catch basin or area drain 18.76 1�vs "`�``C*' Drywell,leach line,or trench drain 18.76 City/State/ZIP: /I 1 a o.P c)> y Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: l Project name: �� ! Manufactured home utilities 50.03 Cross street/directions to job site: 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 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 `PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Q'w ���� M�t�r Floor drain/floor sink/hub 25.02 "7,. ... Address: 304-.5 ...5 r� it .rG,frc.e Zov I f- Garbage disposal 25.02 City/State/ZIP: T}19 a..rcL t C)r 1?777_,1 Hose bib 25.02 Phone:(s43) 5 97- 7 cieec, Fax:( ) Ice maker 12.51 )'APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: -Pa u t M e e r r-rt c j e v- Primer 12.51 Contact name: S 1 _ Roof drain(commercial) 12.51 Address: / 3 0 5'5 .3 .,Sat',.t fa rn es L ft, Sink/basin/lavatory 25.02 City/State/ZIP: 7-;%,Q r d, t2 r c 722[ t Solar units(potable water) 62.54 Phone:(,44 ...5- q 0 .. 7980 `�I Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: ?f bv/ )/t,cr/t.fa A.a_, ryt CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: S CL ,- Water piping/DWV 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* m,40411111110' TOTAL PERMIT FEE .. I Print name: 4 u ( P.'S eG►-r1.ei -. Date: ,,,5 jl Q q This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:l Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-I"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater _ $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to 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 (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 engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram ❑ 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 WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Electrical Permit Application \SV FOR OFFICE USE ONLY 0, City of Tigard Q Received i� Permit#: �M(f_ 4 I . • 13125 SW Hall Blvd.,Tigard,OR 97223 �Q1 Plan Review IN Phone: 503.718.2439 Fax: 503.598.1960 ^^� 1 `% Date/By: Related Permit#: Inspection Line: 503.639.4175 AIN taV _Ready Date/By: luris: ® See Page 2 for T I G A R D Internet: www.tigard-or.gov ��O�`C�� `` odfied/Method: 1G Supplemental Information TYPE OF WOR1�v1 1 PLAN REVIEW ❑New construction .54 Addition/alteratio Cnt Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. (X1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: /30s5 L.tV I00HP or more. ❑"A","E","I-2","1-3°, City/State/ZIP: ,Q ❑Six or more residential units. occupancy. ty �, a 12� LI! 4 7 y 0 Health-care facilities. 0 Recreational vehicle parks. v Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I ' New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential • (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 (PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: ?a-a- f J..\e e y j-vke r e 200 amps or less 100.70 2 Address: / 3 0 5 5 s 1_,,,,j 201 amps to 400 amps 133.56 2 S ri� pT4''M1ef L iti 401 amps to 600 amps 200.34 2 City/State/ZIP: % �cC Or 9 22 if 601 amps to 1,000 amps 301.04 • 2 Phone:(,moo') 10 _ 7.q AG Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: 3i' h v -- m a w.f� fi G��� relocation Owner installation: ••s in.'. .tion is being made on property that I own which is not 200 amps or less _ 59.36 1 intended for sal: .. .. ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 -ice Owner signature: ,=� Date: ,f f(q/(� 401 amps to 599 amps 168.54 2 I I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel ANT A.Fee for branch circuits with Business name: ?a,/ in ee v M0►v e r above service or feeder fee, a 7.42 2 each branch circuit Contact name: L` B.Fee for branch circuits without _ _ _ service or feeder fee,first 56.18 2 Address: 13 n S _S µe S a r el_ - �Ta-1-�es 4 it, branch circuit f City/State/ZIP: T i Q a rS nx. Ct�L L L c.j. Each add'I branch circuit 7.42 2 J . Miscellaneous(service or feeder not included) Phone:( .c' ) 5. 9!v - 7 g917 Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: .p j- 0 h 4 r? py�c/2. -•ct n C,, C O.I'C Reconnect only 67.84 . 2 T CONTRACTOR Pump or irrigation circle 67.84 2 Business name: _S Q !L"L.. e- Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. _ City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed('/z hr min) _ _ ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. (:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014 440-4615T(1 I/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 Description I Qty. I Each I Total I *_ Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: _ ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: El Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(/2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES _ Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems I Data Telecommunication Installation I I Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:1Building\Permits\ELC_PemtitApp_ELR_ERE.doc Rev 04/21/2014 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 permits. 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 all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will 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 homeowner statement is true and accurate. Print Na : . mi 'pa ...nt Signat - of Permit Applica,t Date Permit#: /�ISTo2D/y-60063 ,> � Address: /30-5-5 Sk.9 rJm''1FS o! 77eq r4 e) er 7;191 Issued by: e 7:2 Date: 51/7A This Copy for Permit Offices 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 13055 SW ST JAMES LN, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - No C of O June 20, 2014 at 9:55:41 AM MST2014-00063 Chip Barnett Violation Summary: Inspector Contractor