Permit Building Permit Application - � 5� aL
Residential ED-3/1/ FOR OFFICE USE ONLY
City of Tigard XPl R Date/By:
4 or-i,� !�S rc� e^
Permit No.: 7�)f c )0.2
Y:
• 13125 SW Hall Blvd.,Tigard,OR 97 + Plan Review
Phone: 503.639.4171 Fax: 503.598 h'C �/ Date/By: Other Permit:, - /Q fo !iyy l
TIG A RD Inspection Line: 503.639.4175 O 240$ Date Ready/By: age 2 for [
Internet: www.tigard-or.gov ��N\ 1 u Notified/Method: Supplemental Information
TYPE OF W I" $ , , REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction " r 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.
❑ I-and 2-family dwelling ❑Commercial/industrial
Valuation: $ yk/()CO
❑Accessory building Multi-family
Number of bedrooms: 3
❑Multi-famil
El builder ❑Other: Number of bathrooms: 3, 5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: /.3765 1,01.(4,e-N.) L-A iv e- New dwelling area: 3-7140 square feet
City/State/ZIP: --r/4a 2 o, o 17z-11 Garage/carport area: /162- square feet
Suite/bldg./apt.no.: Project name: /376 S l4;,,,,Q.,,/ G,Ad C Covered porch area itb o square feet
Cross street/directions to job site: Deck area: �,���� . ' o 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
DESCRIPTION OF WORK work indicated on this application.
c//4 cc F.4 A-*/t.(( A)E-2,.) Lo NJ?iGc4.C--7/NJ Valuation: $
Existing building area: square feet
hf , S JA-r+11-1 ,(Ji' C 9 tier ' (d-S/•I &I New building area: square feet
.M.PROPERTY OWNER
Number of stories:rill - ' 0 1721ANT Name: L NA s Ta p,' ��I
_Type of construction:
Address: ten se 0c...e_HAM ice 1 It Ze Occupancy groups:
) —
City/State/ZIP: 7-14,44. , (-)t...,(-)t..., g 2
7 Ly —
Existing:
r
Phone:(5153 ) 70r6.-7 6 7/ Fax:? ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: evt,e G 5 4-4r Arc..... All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed 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
Business name: bAl'to 1401-40 BUILDING PERMIT FEES*
Address: !t{?3 Z-49'44 /S LA^r9 Dt'l. /P/ea*e refer m fee achedak)
City/State/ZIP: ill 4 E ILL i 7 v Structural plan review fee(or deposit):
Phone:( S`/I) 7`(7- 71 1-Z— Fax:(` ) FLS plan review fee(if applicable): j
CCB lic.: f 5 e3,/ Total fees due upon application:
Amount received:
Authorized signature: ( This permit application expires if a permit is not obtained - 1
within 180 days after it has been accepted as complete.
Print name: (1N,u,T oexielt.� a Date: (e/10/p6 • Fee methodology set by Tri-County Building Industry
( Service Board.
1:\Building\Permits\BUP-RES PermitApp.doc 11/6/07 440-46131(11/02/COM/WEB)
' - - -
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
1,1 13125 SW Hall Blvd.,Tigard,OR 97223 Associat
■ Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
I IGARII
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. ❑ ❑ ❑
4 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 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.
/1 1 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if El El El/ 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 he shown to be a plicable to the •roject under review.
l JUkISDICTIONAL SPECIFICS
23 Five(5 site plans are required for Item I I above. Site plans must he 8-1/2"x 1 I""or I I-x 17"". ❑ ❑ ❑ -
-- — "t )sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and accompanied by 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-RES-PermitApp.doe 03/21/06 440-4613T(11/02/COM/WEB)
L a
Mechanical Permit Application FOR OFFICE USE oNI
City of Tigard EXP EXPIRED RED a Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 la�'LCEW t h �V;fl•� 1 '�L_ •__
11�`y�� an Review Other Permit:
Phone: 503,639.4171 Fax: 503.598.1960 Date/By:
T 16 A R n Inspection Line: 503.639.4175 O 20 pate ReadyBy: luris. 0 See Page 2 for
Internet: www.tigard-or.gov JUN Notified/Method: Supplemental Information IlD
TYPE OF WORK CITY OFTIGt'
Rj llT D NG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑New construction ❑Addition/alteration/repMcemen Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑Multi-family ❑Master builder ❑Other:
Description I Qty. I Ea. 1 Total _
JOB SITE INFORMATION AND LOCATION Heating/cooling _
Job site address: 5 tit-42-151' 04
Air conditioning or heat pump
/37�ia J � (requires site plan showing placement) 2— 14.00
City/State/ZIP: —tic 4/2.0 O,- '17 2-2'3 Furnace 100,000 BTU(ducts/vents) 14.00
I Furnace 100,000+BTU(ducts/vents) 2— 17.90
Suite/bldg./apt.no.: Project name: /376.S e,,, £4'I" " �,eN E Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler(radiator or
hydronic) 14.00 _
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater Z 10.00
Gas fireplace 10.00
N 4 LC" .pA 1-11 L`I A Ge N C.77244.t't 1 a rl Flue vent for water heater or gas
` / fireplace 10.00
Log lighter(gas) y 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 4 10.00
x PROPERTY OWNER I ❑ TENANT
Other:Chimney/liner/flue/vent 4 10.00
Other: 10.00
Name: 0.41 Iu 5 r pilot_.— tAQiytv.- } Environmental exhaust and ventilation
Lo45e Pu144"D�( �
Range hood/other kitchen
Address: T" equipment / 10.00
City/State/ZIP: -/-74 Q Q e p g_ i y 7124 Clothes dryer exhaust / 10.00
/ Single-duct exhaust(bathrooms,
Phone:(Z3 ) 7 y co. 76.7/ Fax:( ) toilet compartments,utility rooms) 5 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: , 10.00
Business name: S-°1/" f7 as X Fuel piping
Contact name: $5.40 for first four;$1.00 for each additional
Address: Furnace,etc. '-
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) Fax::( ) Water heater 2.
Fireplace 1/4
E-mail: Range /
CONTRACTOR Barbecue /
TQO Clothes dryer(gas) /
Business name: /S Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee($72.50)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
CCB lic.: State surcharge(12%of permit fee)
C TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: GN ILts t.-0Al,/el_..-- ✓u-Ai 0y Date:(p/� y_ ` Fee methodology set by Tri-County Building Industry Service Board
(:\Building\Permits\MEC-PermitApp.doc 01/19/07 _ ( 44x0-461/71(_111///02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$2,000.00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30
for each additional$100.00 or fraction
thereof,to and including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and
$1.25 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first$100,000.00 and
$1.10 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:l Building\Permits\MEC-PermitApp.doc 01/19/07 2
Plumbing Permit Application EXPIRED
Building Fixtures RE CE FOR OFFICE USE ONLY
Received
City of Tigard f Permit No.:
D.• 13125 SW Hall Blvd.,Tigard,OR 97223 1 0 :r.p,!'eview �, 1
:I a Phone: 503.639.4171 Fax: 503.598.1960 JUN Date/By: Other Permit No.:
1 �(i^Ij 1 Inspection Line: 503.639.4175 ��,. Z., /By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov era OF ,,)1 t. od: Supplemental Information
TYPE OF WORK $JiLDIN(J s • FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00
❑Accessory building ❑Multi-family SFR(3)bath / 399.00
Each additional bath/kitchen / 45.00
❑Master builder ❑Other: -
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: i 37(,S d,,, L,d ye/L 1 LAP Catch basin or area drain 16.60
City/State/ZIP: -77/44_p p7 5 7 ? 2,3 Drywell,leach line,or trench drain 16.60
JJ Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: l Project name: /374 5 L,a L42•G+J cp fi>s
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Water service(no.linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Jl C.1- r1Gc*CT/?N / S iv Lfir OM,t.,y Backwater valve 16.60
Li Clothes washer 16.60
Dishwasher 16.60
X PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
GK,e/STp/N ult. I►Pt Ltd I57 Expansion tank 16.60
Address: log.513 Co, Dg tIArt pg,o 4/ ZB Fixture/sewer cap 16.60
City/State/ZIP: -net 4449 op- y7 ZZ T Floor drain/floor sink/hub 16.60
Phone:0; ) 7114-767/ Fax:( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ,-,,,,,k_ Q S 71?& Interceptor/grease trap 16.60
Contact name: Medical gas(value:$ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain(commercial) 16.60
Sink/basin/lavatory 16.60
Phone:( ) Fax: ( ) Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 7e/9, Water heater 16.60
Address: _Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) t
Authorized signature:/'
[ -/ TOTAL PERMIT FEE
Print name: Chi£.rs r b fV VAS Date: 6/0(06 This permit application expires if a permit is not obtained within
(( 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMF-PermitApp doe 12/27/06 440-4616T(10/02/COM/WEB) i
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' 55.00 0 to 2,000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer-1st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas Systems:
Water Service-each additional 100' 46.40
Storm&Rain Drain-1st 100' 55.00 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and
including$10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for_
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
(minimum permit fee$36.25) 27.55 and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Inspection of existing plumbing or each additional$100.00 or fraction thereof,to
and including$50,000.00.
specially requested inspections-per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping,adding or replacing fixtures? If"yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2"and
Quantity by(Fixture)Work Performed greater,except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918-780-0040.
Bath -Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
-Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
-Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink -2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal -Commercial
-Industrial
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
-Bradley *Note: If the fixture work under this permit results in an
-Commercial increase of sewer EDUs,a sewer permit will be issued and
-Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
i`Building\Pennits\PLM-PermitApp doc 12/27/06
Electrical Permit Application EXPIRED FOR OFFICE USE ONLY
Received �`(Il hi Permit No.: f ' `-I
City of Tigard Re eiv
:� 13125 SW Hall Blvd.,Tigard,OR 97 ��j�E1D Plan Review
Phone: 503.639.4171 Fax: 503.598 LL
Date/By:: Other Permit:
1 I. n R I Inspection Line: 503.639.4175 Date Ready/By: Juris: in See Page 2 for
Internet: www.tigard-or.gov JUN 10 2008 Notified/Method: Supplemental Information
TYPE OF WORK':,'' ARD PLAN REVIEW
yy t
❑New construction ❑Add ition/alteritibiUte M�� Please check all that apply(submit 2 sets of plans w/items checked below):..
B111_,
p i VISION ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 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.: I Job site address: 1376,5 j✓ LA IA R-11,./ LA) IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 'Ft4 QR-J o Q- 9-7 7 Z 3 ❑Health-care facilities. ❑Supply voltage for more than
f
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: 1376 5 $,,, Lgv2GAl Lri ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less I 145.15 4
Ea.add'l 500 sq.ft.or portion Co 33.40 1
Tax map/parcel no.: Limited energy,residential ' 75 00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
S[..4 Lr FA t-t 1 wI N .) t.,NST2t t Ltt 6 ni residential(with above sq.ft.)
l Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
X PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 64 f[STo P/!U.7°—(/AAA/tii 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: t 0T ce J, Pu/Ltt,( K AO li Ze Over 1,000 amps or volts 454.65 2
r Temporary services or feeders installation,alteration,and/or
City/State/ZIP: -7-14 4kr? 4v_ g7zz y
/ relocation
Phone:(SD? )7 y`- 767/ I Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits–new,alteration,or extension, r panel
si A.Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: t A'V �,pi C 675 G��jy,< B.Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Phone:( ) Fax: :( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: 7-5,0 Signal circuit(s)or limited-
energy panel,alteration,or
Address: extension.Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:( ) Fax:( ) Investigation per hour(1 hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv.Lie.: Industrial plant per hour 73.75
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: C 0 TOTAL PERMIT FEE:
L/ This permit application expires if a permit is not obtained within 180
Print name: Date: ` /06? da s after it has been acce ted as com lete.
CivK-[st-D�N� �A/e+✓�`'J //a y P P
" Number of inspections allowed per permit.
1:\Buildineermits\ELC-PermitApp.doe 05/23/06 440-46151(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building'Permits\ELC-PermitApp.doc 03/23/06
1 (Ft
514 • Building Division i sc
One & Two-Family Dwelling
1 i n H° Fees Checklist
PERMIT INFORMATION:
Permit #: Eft.c. _ Plan #: Date: ( Z31C8
Site Address: 1-`]�,rj ( RE Parcel #:
Subdivision: tit(_(_s({cQe_. Lot #: (A Zoning: .R-7
Jurisdiction: -11& Setbacks: Front: Rear: Left: Right:
Class of Work: 13( ) Stories: First Floor: �' -
Type of Use: -12.-G_'.5 Height: Z Second Floor: ((� 7
Construction: S ' Floor Load: Ex'�d� Third Floor: 575"
Occupancy Group: 1Z3 Dwelling Units: I Bonus Room:
Valuation: *� $8�, le, Bedrooms: ‘ , Total Floors: 3740 ►■r
Bathrooms: Basement:
Decks: 'S C.3 bt--- Garage: 11 62--
Porches: I'2Z '°‘ Other:
FEES: Description: Fee Amount: Amount Paid: Balance Due:
Plan Check: Building: 1 AA4Z tRl 750 ., oo =97— ,(17
Extra Set:
—eJ
Permit: Building:
Tax: { ;-+ --
Metro CET: ? rt:5---
School CET:
Mechanical
Tax: 40-4-7t3-7----
Plumbing: -61- --
Tax: a
Electrical: - ,
Tax: /\c.
Low Voltage:
Tax: -
.
CDC: CDC Ping. Rev.: 4(o-
CDC LRP Fee: (p -
SDC: Parks:.-
TIF Res.:
TIF MT: -94'1‘7 '
Erosion Permit:
Erosion CWS: A . ZO
Erosion COT: 414. zo
Water Quality:
Water Quantity:
SUB-TOTAL:
Sewer: Permit:
Inspection:
SUB-TOTAL:
TOTAL MST & SWR:
I:\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page 1
PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment/systems)
Description I Qty. I Fee(ea.) I Total Description I Qty I Fee(ea.) I Total
New 1-&2-family dwellings Heating/Cooling
(includes 100 ft.for each utility connection) Air conditioning or heat pump* 14.00 2P1,C0
SFR(1)bath 249.20 Furnace 100,000 BTU(ducts/vents) ) 14.00
SFR(2)bath 350.00 Furnace 100,000+BTU(ducts/vents) - 17.90 -¢,tJ
SFR(3)bath I 399.00 ' ,: <9' Gas heat pump 14.00
Each additional bath/kitchen , + 45.00 45 Duct work 10.00
Rain Drain,single family dwelling 65.25 Hydronic hot water system 14.00
Fire sprinkler-sq.ft. 0 to 2,000 115.00 Residential boiler
Fire sprinkler-sq.ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00
Fire sprinkler-sq.ft. 3,601 to 7,200 220.00 Unit heaters(fuel,not electric)
Fire sprinkler-sq.ft. 7,200 and greater 309.00 (in wall,in-duct,suspended,etc.) 14.00
Site Utilities Flue/vent(for any of above) 6.80
Catch basin/area drain 16.60 Repair units 12.15
Drywell/leach line/trench drain 16.60 Other Fuel Appliances
Water heater ?j 10.00 Z--
Footing drain- 1 5� 100' r 55.00 Gas fireplace 10.00
Footing drain-each additional 100' 46.40
Manufactured home utilities 1 10.00 Flue vent(water heater/gas fireplace) l 10.00
Log lighter(gas) 4 10.00 °
Manholes 16.60 Wood/Pellet stove 10.00
Rain drain connector 16.60 Wood fireplace/insert 10.00
Sanitary sewer- l 100' 1 55.00 Chimney/liner/flue/vent 10.00
Sanitary sewer-each additional 100' 46.40
Storm sewer- 151 100' 1 55.00 Other: 10.00
Environmental Exhaust&Ventilation
Storm sewer-each additional 100' 46.40 Range hood/other kitchen equipment j 10.00 tO -
Water service- 151 100' 1 55.00
Water service-each additional 100' 46.40 Clothes dryer exhaust 1 10.00 t O -
Fixture or Item Single duct exhaust
Absorption valve 16.60 (bathrooms,toilet compartments, •-
Backflow preventer 27.55 utility rooms) 6.80
Backwater valve 1 16.60 Attic/crawl space fans 10.00
Clothes washer 1 16.60 Other: 10.00 ,
Fuel Piping
Dishwasher 16.60 **($5.40 for first 4,$1.00 each additional)
Drinking fountain 16.60 • Furnace,etc. •Z **
Ejectors/sump 16.60 Gas heat pump **
Expansion tank 16.60 Wall/suspended/unit heater **
Fixture/sewer cap 16.60 Water heater **
Floor drain/floor sink/hub 16.60 Fireplace **
Garbage disposal 16.60 Range **
Hose bib 16.60 BBQ **
Ice maker 16.60 Clothes dryer(gas) ( **
Interceptor/grease trap 16.60 Other: **
Primer 16.60 Total: ( ( (2-A0
Roof drain(commercial) 16.60 Mechanical Permit Fees
Sink/basin/lavatory(commercial) / `7 16.60 Subtotal: $ •2to 20
Tub/shower/shower pan ' 16.60 Minimum Permit Fee$72.50 $
■
Urinal 16.60 • Plan Review Fee(25%of Permit Fee) $
Water closet A 16.60 State Surcharge(12%of Permit Fee) $ 0 Z
Water heater 16.60 TOTAL PERMIT FEE $ Z� �*,ZZ
•
Other:
Other:
Plumbing Permit Fees ELECTRICAL FEES(residential single-or multi-family)
Subtotal T $ 444f Description Qty. Fee Total Insp
Minimum Permit Fee$72.50 $ 1,000 sq.ft.or less 1 145.15 4
Plan Review(25%of Permit Fee) $ Ea.add'l 500 sq.ft.or portion �5 33.40 1
State Surcharge(12%of Permit Fee) $ 3g,2 Limited energy,residential t 75.00 - 2
TOTAL PERMIT FEE $ �` �,Z�3 Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Electrical Permit Fees
Subtotal: $ 40-2._ • '3G-
Plan review(25%of permit fee) $
State surcharge(12%of permit fee) $ 41 ' 4
TOTAL PERMIT FEE $ A-(o I ,
I:\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page 2
84-
RESIDENTIAL PERMIT APPLICATION REVIEW
Permit No.: (Y)937-2008- 000 6,2
Site Address: 76'5- 5W Ga uc<<i n-e
Subdivision:
Lot No.:
Contact Name: chr; fo h„ - Ijarr�e'
Business:
Street: /p 95-5 (w 3) 11& v
City: T;ca vc) State: ore tip: rf?.22
As required by the 1999 Legislative action (Senate Bill 587),your residential permit application and
plans have been reviewed to determine if it is complete and if the plans are deemed "simple” or
"complex"as defined in ORS 455.467 and 455.469.
❑ The application is complete.
® The application is incomplete for the following reason:
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in5101al'1 - v(ic.
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o f 2/ F nerg y Cole CO+-n fi vi c< .
l The submitted plans will be reviewed;however, a permit cannot be issued until the above
information is reviewed and/or approved.
KI The submitted plans cannot be reviewed until the above information has been submitted
and/or approved.
I I The plans are deemed "simple".
The plans are deemed"complex".
Signature:
Name: Brandon Shaw Date
Title: Plans Examiner
Phone: 503-718-2425
E-Mail: BrandonS @tigard-or.gov
I:\Building\Forms\RES-PermitAppRevw-Blank.doc 1/18/07
RESIDENTIAL, PERMIT APPLICATION REVIEW
Permit No.: irjt5T,.2008 - Co06
Site Address: /3 7(, ,r 5 u La n.e
Subdivision:
Lot No.:
Contact Name: C hr ; S> h ()a
Business:
Street: 1U q5 S w 1�,,r 114 vn
City: T; c�a v.c) State: CG r Zip: cf ?.„2
As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and
plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or
"complex" as defined in ORS 455.467 and 455.469.
❑ The application is complete.
• The application is incomplete for the following reason:
It /6/ CdoSS Sec^ ko» s — Call / /co l Sit 4in;
VLS
ce; \1r, 6; 411.e+rna/
ivlS t,)c ( eC
2 0 1-c, 1 Poo - A-A 0.1 g - - c r ✓us ',15
E ners y (c,c) e Covn ;4 vi c e
❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above
information is reviewed and /or approved.
The submitted plans cannot be reviewed until the above information has been submitted
and /or approved.
❑ The plans are deemed "simple ".
?C The plans are deemed "complex ".
Signature:
Name: Brandon Shaw Date
Title: Plans Examiner
Phone: 503 - 718 -2425
E -Mail: BrandonS @tigard - or.gov
I \ Budding \ Forms \RES- PermitAppRevw- B1ank.doc 1/18/07