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Permit IICITY OF TIGARD MASTER PERMIT - q s COMMUNITY DEVELOPMENT Permit#: MST2014-00167 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/06/2014 T I Ci A R D Parcel: 2S 1038808200 Jurisdiction: Tigard Site address: 12280 SW 124TH AVE Subdivision: LAKE TERRACE Lot: PTS 9-10, PLUS P Project: PARKER Project Description: Interior remodel. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn>=10OK: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 20 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: ALT SF VB R-3 0 Owner: Contractor: PARKER,CHERYL OWNER Required Items and Reports(Conditions) 12280 SW 124TH AVE CHERYL PARKER TIGARD,OR 97223 12280 SW 124TH AVE TIGARD,OR 97224 PHONE PHONE FAX: Total Fees: $1,967.83 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 952-00 10 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issu d By: ,k Permittee Signature: . Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Buildmg Permit Application Residential FOR OFFICE USE ONI.1 City of Tigard Dates : / 100 Permit No.: / _toy , i 13125 SW Hall Blvd.,Tigard,OR 9 Received plan Review- '' . Phone: 503.718.2439 Fax: 503.598. � DateB : Other Permit: I. I I,, ,I:I, Inspection Line: 503.639.4175 '' '\ Date Ready/By: Juris. ® See Page 2 for Internet: www.tigard-or.gov KC' V Notified/Method: Supplemental Information TYPE OF WORK 'V +��,Q,` REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑De �` ".'1 Permit fees*are based on the value of the work performed. 4SV�'- Indicate the value(rourded 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. Ar 1-and 2-family dwelling — Valuation: $ J� � y g ❑Commercial/industrial / ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 22 SS C e,,M I 2.4 i\1 , New dwelling area: square feet City/State/ZIP: ¶; �,e C 1 Garage/carport area: s uare feet y 1 1 CO�� r L'Y�-- '� 7 C� q Suite/bldg./apt.no.: Project name: Lct+(t rust, ref",E;( Covered porch area: square feet Cross street/directions to job site: I 2.441► q- inn ('+ . Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: i,..-6Z K? I-eV-rat Lot no.: 10 Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rourded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the . . DESCRIPTION OF WORK work indicated on this application. IValuation: $ 04--e(IC'f re 111C - ( Existing building area square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: (, Y 1i✓r 7 pa( ( Type of construction: Address: 45 )4)/1/11&CO( L r . Occupancy groups: tN City/State/ZIP: - .(a Y 7( l I L 1122-S— Existing: Phone:(603) Cii,Ci _SZe:i"1 dC Fax:( ) New: 'sf APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* 1 r max )Business name: e.Pa(o r (604`)C*alit_ Structural plan review fee(or de posit): Contact name: \....)..e f nt e. 11a C SC Y) Address: •VZ }. LS plan review fee(if applicable): `�W iiik.0 r;1, f C.A. City/State/ZIP: TL'Ctrel , c r7 .7-7-3 Total fees due upon ap{>fication: �iGfly jy Amount received: cif L1.74_: /y Phone:( ) 5 1 .4 q S�h Fax: :( ) / E-mail: i en na S c � (60.,hcn , r c^n.i PHOTOVOLTAIC SOLAR PANEL SYSTEM IDES* ,, Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: 6 W Al e Submit two(2)sets of roof plan with connection details _ - — and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist.- • Permit Fee(includes plan review City/State/7.1P: and administrative fees): $180.00 _Phone Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: - Total fee due upon appication: $201.60 Authorized signatu /�� This permit application expires if a permit is not obtained j within 180 days after it has been accepted as complete. Print name: \.) 11( .....ti ,y) Date: q/29//4- *Fee methodology set by Tri-County Building Industry Service Board 1:1Building1PermitsBBUP-RESPermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY ErCity of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 Date/13y: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing [11 \ILLI,,,,,,..a Internet www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1"es 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. 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 a,.licable to the 'ro'ect under review. .1l RISUI( I'IONAL SPECIFICS 23 Three(3)site plans are required for Item 1 I 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 Buildingplans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ ❑ ❑ 26 "Reversed"buildingplans must meet criteria outlined in the Permit&System Development Fees document. , ❑ ❑ CI 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-RESPertnitApp.doc 02/24/2011 440-4613T(11/02/COM/W EB) Electrical Permit Application 1 O 0111( 1 I ",I 0\I 1 City of Tigard Received-*Ii) Plan Review 1' IN • 13125 SW Hall Blvd.,Tigard,OR 9 • Phone: 503.718.2439 Fax: 503.59 Date/B : Related Permit#: Inspection Line: 503.639.4175 2 1°4 Ready Date/By: ruris: VI See Page 2 for 1 I c' \1.1> Internet: www.tigard-or.gov C t\ Notified/Method: Supplemental Information TYPE OF WORK+ 1t PLAN REVIEW ❑New construction 8TAddition/alteratiot I ` Please check all that apply(submit 1 sets of plans w/items checked): ❑Demolition ❑Other: gV, �, 4I . ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. (: 1'1-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#: I Job site address: I(.212.9S0 i 0`k` k-'L IOOHP or more. ❑"A","E°,"I-2","1-3", City/State/ZIP: C 6172,-2,3 ❑li3 ❑Six or more residential units. occupancy. parks. ❑Health-care facilities. Recreational vehicle arks. Suite/bldg./apt.#: I �� Project name: W/,1 t�' ,qty ❑Hazardous locations. ❑Supply voltage for more than M '� 1 t L ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: ) LL.`S -t- 7S11t1 a+ - FEE SCHEDULE Description I Qty. I Each I Total I " New residential single-or multi-family dwelling unit. Subdivision: I-4 Ile 1 e 1 fa(el. I Lot#: I Q Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 Qdcl JO �1 tU� S �„ (with above sq.ft.) V Limited energy,multi-family (t0(.4 �� residential(with above sq.ft.) 75.00 2 �� t t�� Rene able Energy ❑ See Page 2 0-PROPERTY OWNER ❑ TENANT ery s or feeders installation,alteration,and/or relocation Name: { '114 c :t i i , II ` mps or less / 100.70 1eX1.7v 2 Address: (0G w 90 Not d LA. 01 amps to 400 amps 200.34 2 _ �� ,•,,,(401 amps to 600 amps 200.34 2 City/State/ZIP: alY1 / ct722 S • �) . 601 amps to 1,000 amps 301.04 2 Phone:( ) 31pC�- >t(,r7 tv Fax:( ) 4.7�N Over 1,000 amps or volts 552.26 2 r" L �,1 Temporary services or feeders installation,alteration,and/or Email: ;IS gam. relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease rent,or ex an e,according to ORS 447,449,670,an 701. 1I 201 amps to 400 amps 125.08 2 Owner signature: n/�� Date: q j 2Q/1 4- 401 amps to 599 amps 168.54 2 , ,- APPLIC I ❑ CONTACT PERSON Branch circuits-new,alterations ot:_!xtension,per panel A.Fee for branch circuits with Business name: r n `, {� above service or feeder fee, �" 1 �� ` �~'r` t `^ each branch circuit ,Rig. 7.42..1 it 2 Contact name: i �_ e, ' B.Fee for branch circuits without �� ,r ) t• service or feeder fee,first Address: I GZ l I S I B �t '' 56.18 2 ��I11( branch circuit City/State/ZIP: '`-"� �'1�V 1)1722 a O. Each add'I branch circuit 7.42 2 1 ( rZ �/ Miscellaneous(service or feeder not included) Phone:(ST3) 4.I)., S C) C/C) I Fax::(61B) 2Se -61 13C} Each manufactured or modular 1 67.84 2 dwelling,service and/or feeder Email: jC'Jn hGl SSGy1 e3h(.2") C vlf 1 Reconnect only 67.84 2 NCO CTOR Pump or irrigation circle 67.84 2 Business name: ,. O l�t. G Sign or outline lighting 67.84 2 I —1 .w . v.r.- Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: I 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:( I Fax:( ) Investigation(1 hr min) 66.25/hr II I J I ' Email: Industrial plant(1 hr min) 78.18/hr V `J Inspections for which no fee is 90.00/hr CCB Lic.: ' Electrical Lic.: Suprv.Lie.: specifically listed('/2 hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: Subtotal: Wig,it) Print name: -1 Date: ❑Plan Review Required(25%of permit fee): _ State surcharge(12%of permit fee): Ali‘119 Authorized signat re: .L—,��i TOTAL PERMIT FEE: �Sf��! This permit application expires if a permit is not obtained within 1 0 Print name: n n ee Date: C-1'//2_ei / f days after it has been accepted as complete. ` / • Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4oisT(II/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 1 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 ❑ Audio and Stereo Systems* 1501 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 with OAR 918-3019-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr I 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 ❑ 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 6, I.\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard Received s. DateB : Permit No.: S . V j y-co 1477 • 13125 SW Hall Blvd.,Tigard,OR,972. Plan Review Other Permit No.: '� Phone 503.718.2439 Fax. 503.598. cili\\*10 Date/B I IC,;\RI Inspection Line: 503.639.4175 ' q '104 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov Z∎ ` U Notified/Method: Supplemental Information TYPE OF WORK •, t FEE* SCHEDULE• ❑New construction ❑ 1 ' is s.,� • For s I ecial in ormation use checklist Descristion IBM Ea. Total F Addition/alteration/replacement ❑ 1..,‘‘ New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 .61-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 2236 ilk 104-44.- � Catch basin or area drain 18.76 •-�� ✓" M� Drywell,leach line,or trench drain 18.76 1 1 City/State/ZIP: f C\ q 172 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: ■ro. - .II Ii i� Manufactured home utilities 50.03 Cross street/directions to job site: ' �ra a A Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear It.: ) Page 2 Subdivision: 4a, -re Yae. l Lot no.: 10 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 De I'i- `rAt, Pat-harms Dishwasher 25.02 kid --Fitt) Bata c of Drinking fountain 25.02 MOW, VA+64.00 fjIll rj Ejectors/sump ■ 25.02 --Ikt PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: OA/WA-J,1 L Pet e)r Fixture/sewer cap 25.02 I" Floor drain/floor sink/hub 25.02 Address: 5 (co DQL'jt,L^` Garbage disposal 25.02 City/State/ZIP: Tb r+ f ( / ( , 01/226- Hose bib ■ 25.02 Phone:(9:A) CI , -5 , L9 Fax:( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: V 'l tip`U,( Cun i� �' Medical gas(value:$ ) Page 2 o f te i 1,i%� Primer 12.51 Contact name: 'I 'rTj� Roof drain(commercial) 12.51 i Address: 1 // ( Ibi - Sink/basin/lavatory Mil 25.02 City/State/ZIP: 'Am rA * • 22 Solar units(potable water) 62.54 Phone:( )'. _ O Fax::( ) Tub/shower/shower pan 12.51 Mil J e y_,�c� & cj1 pD C< Urinal _ 25.02 E-mail: L r}fI� (' CO CTOR Water closet 25.02 [TIE Water heater - 37.52 Business name: 1 /\ cc ! ._____ s. •_ _ Water piping/DW V � 56.29 Address: . - - Other: 25.02 City/State/ZIP: Subtotal , _ Phone Fa' Minimum permit fee: $72.50 CCB Lic.: r Plumbing Lic.no.: Plan review (25%of permit fee) s - State surcharge(12%of permit fee) . Authorized sign ure: t,, 1 TOTAL PERMIT FEE 0 . Print name: ?� W f i I ®�� This permit application ehpires 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.\Building\Permits\PLMtJ_PermitApp,doe 10/01/09 440-46!6T(I0/02/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-1'100' 50()3 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 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 El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure -Drive Thru 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 CI Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4 El 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 MachiRefrig.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 P Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 Mechanical Permit Application tO1(()t 1It l l �I (,\l l City of Tigard Received Date/By: Permit No.: i NI _� • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review g 7 Phone: 503.718.2439 Fax: 50 3.598. c Date By: Other Permit: Inspection Line: 503.639.4175 't I c n :I Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov `1,1° Notified/Method: Supplemental Information 9CZ 4A\� TYPE OF WORK i ‘N'' N COMMERCIAL FEE* SCHEDULE – USE CHECKLIST ilk Mechanical permit fees*are based on the value of the work 12 New construction Addition/alteratio , :.' '. performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: ; mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES" 1-and 2-family dwelling ❑Commercial/industrial El Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description 1 Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Q C^.' Air conditioning 46.75 Job site address: 122 0C , vv 1• '-C' Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-1 O C1(Ct / � C/l).')j_ Furnace 100,000+BTU(ducts/vents) _ 54.91 J Ice � p_ Heat pump 3 61.06 Suite/bldg./apt.no.: Project name: �{�o �J�/ Duct work 23.32 Cross street/directions to job site: i 2A 44- k ,f y1 . Hydronic hot water system 23.32 _ 1 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: Lake -(7(( t e. 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 In,t ?Y u '( t"Q(yri%(f I fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 ROPERTY OWNER I ❑ TENANT Environmental exhaust and ventilation: Name: ( 1tic trt kp Rt re r Range hood/other kitchen (%J� f"� F equipment 33.39 Address: r^ }^ 7 (� � ,tiCz'>? Clothes dryer exhaust 33.39 City/State/ZIP: pjo( /� J . 61"7'2 Single-duct exhaust(bathrooms, y f""` ' "" ( ! t�S`` toilet compartments,utility rooms) 2- 23.32 Phone:(O ) C)(cCi.5-cg, Fax:( ) Attic/crawlspace fans 23.32 .APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: r]a r �j ' ^(��+h $14.15 for first four;$4.03 for each additional •Contact name: nnt.e -i-k Swn Furnace,etc. _ <51A) Gas heat pump v2'4" V 41--+ '! Wall/suspended/unit/unit heater City/State/ZIP: I!Oa�`1 / �v Water heater I 5'y,j Phone:(53) S'47 –, 6169 rO Fax::( ) Fireplace �� Range I _ E-mail: J 2 v1 ha c.cc n �-/ L jCL IOC , (Nil Barbecue CONTRACTOR Clothes dryer(gas) • Q 1, f , f Other. Business name: – 1/ /� ` ,_� MECHANICAL PERMIT FEES* _ Address: Subtotal !y u City/State/ZIP: — Minimum permit fee($90.00) _2% . Plan review(25%of permit fee) Phone: • Fa State surcharge(12%of permit fee) j IC. by CCB lic.: . TOTAL PERMIT FEE Via).$ _ This permit application expires if a permit is not obtained within I80 days after it has been accepted as complete.-IMF Authorized signat re: • Fee methodology set by Tri-County Building Industry Service Board Print name: I 1 ■tom / Date: 61/2.C1 1 t 1 I:\Building\Permits\MEC_PermitApp_040113.doc 440-46177(I 1//02/COM/W EB) 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:\l3uilding\Permits\MEC_PermitApp_040113.doc 2 October 8, 2014 RE: ALTERATION Project Information Building Permit: MST2014-00167 Class of Work: Alt Address: 12280 SW 124th Ave Lot Number: 10 Area: 1767 Sq. Ft. Stories: 1 Builders Name: JC Parker Subdivision: Lake Terrace The plan review was performed under the State of Oregon Residential Specialty Code (ORSC) 2011 edition. Please respond to conditions below. 1 ) Provide details of garage conversion to living space. What type of floor, insulation, vapor barrier on floor? 2) Show lateral design for rear wall. 3) Show type of windows in bedrooms to verify egress windows. 4) Show roof framing to identify where bearing walls are. When responding, provide an itemized letter stating in what way each numbered issue has been addressed in the revision. When submitting revised drawings or additional information, please attach a copy of the enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard in tracking and processing the documents. Respectfully, Dan Nelson Senior Plans Examiner (503) 718-2436 dann @tigard-or.gov FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter i i c;;\It l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: /2 DATE TIMED DEPT: BUILDING DIVISION J i1�,�� N fl V 4 2014 FROM: LiCA//v.7Ce.- CITY OF AGAR() COMPANY: i C I Yk-e...- 6,,, Lea BUILDING DIVISION PHONE: 503-5-L/7 —CJ J''O By: RE: /2 51-J 64 21'Arc_ /57 Djy— x/(07 (Site Address) (Permit Number) lrKGi- ro�ject name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: _ Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): t= ,,,h'‘,,,^) ' REMARKS: FOR OFFICE USE ONLY Routed to Permit Technician- Date: j ( 15 ( Initials: Fees Due: ❑ Yes E o Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: (:\Building\Forms\Transmittal Letter-Rev isions.doc 05/25/2012 FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT IIIII _ 111 Transmittal Letter I i,,,\It l 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 1)02-4(-- - DATE RECEIVED: DEPT: BUILDING DIVISION HJrflJh ti 117-1 i OCT14 ; FROM: ( 1O(e- Sc( CITYOF litilittiu COMPANY: a.i I PHONE: 503 _ 5( 5"-- // BY: RE: 12/50 11/1) / i CkiffiLL74- /425- /i, CX)— /(y 7 (Site Address) (Permit Number DitM .. Pa( W 0 .r% '°- 'roject name or.11P'vision name an• of numIer ATTACHED ARE THE FOLLOWING ITEMS:_ Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: . Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. —X—Beam calculations. Engineer's calculation Other(explain): REMARKS: r r l cjyr o 4 001 t97 FOR OF ICE USE ONLY Routed to Permit Technician: Date: ((OFFICE ( ik- Initials: 0 Fees Due: ❑ Yes ❑ Fee Description: i Amount hue: $ $ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: _ Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 • 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. por i! 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 Name o Permit Applicant / / /ao IL/ Signature of P it Applicant Date Permit#: /1—CTo20/1/— 00/6 7 Address: a � y 2(Fa .5 .� .;% C 6? Issued by: �, Date: //A//f 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2014-00167 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL MST2014-00167 George Heimos NOTE: master bathroom and kitchen sink (only) pass, ok for use 1. Complete dishwasher and both bathrooms not ready for inspection, no inspection made. 2. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 Dickson@gmail.com 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2014-00167 David Young Provide approved electrical and plumbing ﬁnal inspections prior to building ﬁnal. All can be scheduled at same time. 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2014-00167 David Young Smoke detector not working in new bedroom. Provide approved plumbing ﬁnal inspection. 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL MST2014-00167 David Young Dishwasher hose to be secure close as practical to top of cabinet. 807.4 All else ok. 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2014-00167 David Young Correction complete. 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2014-00167 David Young Correction complete. 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 12280 SW 124TH AVE, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - No C of O MST2014-00167 David Young Correction complete. Violation Summary: Inspector Contractor