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Permit
CITY OF TIGARD MASTER PERMIT IN 2. .- COMMUNITY DEVELOPMENT Permit#: MST2015-00048 °,;_ ct a Date Issued: 04/14/2015 T[GARD D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103AC01800 M' Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: LIN Project Description: 2 story addition of 112 sq ft to create laundry room and bath room. 7/26/18: REPRINTED permit to show change change of owner from David Booth to Jessica Lin. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 56 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 21 Bathrooms: 1 Second: 56 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 112 sf Value: $20,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 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: 1 0-200 amp: 0 W/Svc or Fdr: 10 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 112 Owner: Contractor: LIN,JESSICA CHIACHI STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 498 JEROME ST PO BOX 40475 SAN JOSE,CA 95125 EUGENE,OR 97404 PHONE: 408-368-0739 PHONE: 541-521-1553 FAX: Total Fees: $1,329.70 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 - -:•pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0090. You may obtain a cop of the rule•or direct questions to OUNC by calling 503.232.1987 or1.800.332.2344. Issued By: o s? _ Permitfee Signature: 02,, (/ 44' Call.P.. 9.4175 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. n CITY OF TIGARD MASTER PERMIT 11111 a COMMUNITY DEVELOPMENT Permit#: MST2015-00048 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2015 Parcel: 2S103AC01800 Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: Booth Project Description: 2 story addition of 112 sq ft to create laundry room and bath room BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 56 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 21 Bathrooms: 1 Second: 56 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 112 sf Value: $20,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 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: 1 0-200 amp: 0 W/Svc or Fdr: 10 Ea add/500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 112 Owner: Contractor: BOOTH,DAVID K STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 3005 N PACIFIC HWY W PO BOX 40475 RICKREALL,OR 97371 EUGENE,OR 97404 PHONE: PHONE: 541-521-1553 FAX: Total Fees: $1,284.70 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be don. ' -•,.. •.. - 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 da -. ATTENTION: Oreggn law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR eto 9' -001-0010 through OAR 9 - 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ued 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. J • Building Permit Application f ECEIVEp Residential t w ()l U I 1 s I ()NI 1 City of Tigard 4PR 1 2015 Received �e Permit No.. /5 Oct -!• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan• vie•'4s „IN' Phone: 503.718.2439 Fax: 503.59�1Pfey Date/B : /• M• Other Permit: I 1 t,A 1:1) Inspection Line: 503.639.4175 U!� I'GAM) Date Re. y: Juns: la See Page 2 for Internet www.tigard-or.gov BUILDING Dim/0N Notified/Met 4 •, 7 t)' o Supplemental Information TYPE OF WORK REQUIRED REQUIRED DA,TA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition 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. Valuation: $ l VD U 14 1-and 2-family dwellin g ❑Commercial/industrial Uindustrial El Accessory building ❑Multi-family Number of bedrooms: -e-~ ❑Master builder ❑Other: Number of bathrooms: I JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 11.2,0 Q 3vj 4-ow,1C. si- New dwelling area: 6 1 square feet City/State/ZIP: i c r 0� °'1-'Z"L3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area lir square feet Cross street/directions to job site: C j 34 Deck area: square feet Other structure area: square feet T REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: w4. G( Lot no.: �„! Permit fees* are based on the value of the work performed. Tax map/parcel no.: 2. S t Q irCO ,$0 V 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. Valuation: $ old, w r+ L�.K4ley s Existing building area square livi-3 t xf-e-visi a %111 Y VP\ L ! IkA.ST 2-0 l 00 1 1 New building area: square feet M PROPERTY OWNER ❑ TENANT Number of stories: Name: rD6vj k B't'44 Type of construction: Address: 3 D-t , ?qCt T"i1` 41 t lr - Occupancy groups: City/State/ZIP: R i Lk�i i 0 11-3 ( Existing: Phone:( )3) 33 2 3 ( '})- Fax:( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedele) Business name: Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon applicati. : City/State/ZIP: Phone:( ) J Fax::( ) Amount recei ed: #0,14/5-. 41 E-mail: PHOTOVOLTAIC SOLAR PANEL ' . - -: CONTRACTOR Commer . • d residential prescriptive installation roof-top mount:. '•otoVoltaic Solar Panel S . Business name: ` Submit two(2)sets o ..f plan with c.• ction details 5 �/ ,(V 1 �p 13 {' D1s�(�Y and fire department access, . ong .•. the 2010 Oregon Address: / b G.. _ . , M r _ Solar Installation Specialty C. • checklist. City/State/ZIP: I ii N Permit Fee(inclu• plan r- 'ew y •r A ' ` an nistrative fee • $180.00 Phone:(54 1) 5-2_1 S 5-3 Fax:( ) Sta - - arge(12%of permit fee): ' $ 1.60 CCB lie.: 1-4.9 03-3 Total fee due upon appication: $201.60 Authorized signature: r% This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete.-121 Print name: J ��� Date: -I - S *Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Associated permit. TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Med,amcal Internet www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 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 j 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 he shown to be applicable to the .ro'ect under review. Il RISDICI'IOfAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". _ ❑ ❑ , ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) • Electrical Permit ApplicationtisCtIVI41 41 FOR OF-FiCI. 1 ,1 t tv 1 , City of Tigard Received l/ � Hyr �s— `g •J ' Date/By: Y i //' Permit No.: 4G' '�Yl Gt�"/ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 74 Phone: 503.718.2439 Fax: 503'598.I96p p R 1 2015 Date/By: Other Permit: T 1-A R D Inspection Line: 503.639.4175 HH Date Ready/By. Anis. H See Page 2 for Internet: www.tigard-or.gov Notilied/Method Supplemental information TYPE OF Wti1 a 4' a PLAN REVIEW vlt t New construction Addition/altpt'�cquh'tplaeemenf Please check all that apply(submit 2 sets of plans whims checked below) ❑Service or feeder 400 amps or more 0 Building over three stories. El Demol ikon Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. Isg‘ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations, buildings. 0 iulti-family ❑blaster builder ❑ less to ground,or exceeds 14,000 ❑Commercial-use agricultural Other: ©Fire pump. Installation of 150 KVA or JOB Sill"- t.1 FORMATION �iiD LOCATION ❑Emergency system. • larger separately derived system. ['Addition of new motor load of Job no.: Job site address: t t l�0 L,h% Fo o le�r lOOHP or more. occupancy. t 0 Six or more residential units. ❑Recreational vehicle parks. City/State/ZiP: t k tat , ❑Health-care facilities. ❑Supply voltage for more than J ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to_job site: '[3 Dexrirption _t.ct_ I -K. - 1orot i _ New residential single-or multi-family dwelling unit. i includes attached garage. Subdivision: Wa p -- Lot no.: -b I,000 sq.ft.or less 168.54 4 3 ! b 1 1�� gyEa.add'l 500 sq.ft.or portion 33.92 I Tax map/parcel no.: l 0 V 1. Limited energy,residential DESCRIPTION OF WORK (with above sq.it) 75.00 2 '' p Limited energy,multi-family f e 200 t{v&r se vice g 4 t d (4 1 re residential(with above sq.ft.) 75.00 ., newp { 1 - Renewable Energy 0 See Page 2 1)et Se et4. g, 9 1 f t'� 1 , Services or feeders installation,alteration,and/or relocation PROPERTY OWNER 1 ❑ TENANT i 200 amps or less _ 10070 (�r �()1 '1 201 amps to 400 amps 133.56 2 Name: c&t 4 1/1 B 401 amps to 600 amps i 200.34 2 Address: -3005— N , - K C i P.v L 41 w . 601 amps to 1,(X10 amps 301.04 t 2 ^-� 2 ���� 1111 � Over 1,000 amps or es or 552.26 2 City/State/ZIP: `-4 k w l O 3 Temporary services or feeders installation,alteration,and/or Phone:(5b3)3 3 Z 'S CI .)- Fax:( ) relocation 200 amps or less 59.36 I Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 _Owner signature: _ _ _ Date: Branch circuits-new,alteration,or extension,per panel ❑ /APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, �6 7.42 7(4,2o 2 Business name: each branch circuit - - B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch circuit Address: Each add'l branch circuit_ 7.42 2 Miscellaneous(service or feeder not included) City/State!ZIP: Each manufactured or modular 67.84 2 dwelling,service and/or feeder Phone:( ) Fax::( I Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 !� CONTRACTOR Sign or outline lighting 67.84 2 Business name: G q 3. E i ee- 'fi C CD Z, - Signal circuit(s)or limited-energy see panel,alteration.or extension. Page 2 2 iAddress: go t vi 1,-)slit) D r Each additional inspection over allowable in any of the above City/State/ZIP: G r s j1q ,tit Q q?6 St— Investigation inspection(t hr min) 66.25/hr f u "` Investigation(1 hr min) 66.25/hr Phone:(S63 ) Lt CS'.%I 5" Fax:(�fb3 ) 1-1:175-' /7 Industrial plant(1 hr min) 78.18/hr inspections for which no fee is CCB I.ie.:3Q303t{ Electrical Lie.:C/Ofd Suprv.Lie.: ci S7S specifically listed etr hr min) 90.00(hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: �� Subtotal. / 'jet i 0 Plan review 25%of mtit fee 1 Print name: et fl R 6 n Date: l�M f�L >3 f ;?0/5" ( ix ) _ _ I State surcharge(12%of permit fee):_ a,6 t 9 Authorized signature: j 1 j R ;�� O,,.1 TOTAL PERMIT FEE: 1 e1 S`;Qj 3__ f� p Q I ' "1 .4, 31 This permit application expires if a permit is not obtained within 186 Print name: V et I�� h 141 � f� Datel r r� t r- drys after it has been accepted as complete. 11__ " Niunber of inspeclloin allowed pci ix-runt. t\BuildingPemtitsiELC_PumitApp_ELR 6RE.dw Rev 0512112013 4404615T(I11c5/COM/w t3 Mechanical Permit ApplicationE CEIVE ` FOR OFFICE USE ONLY City of Tigard ReceiveDate/By: illiMMI PermitNo.: lJ� ,r �� 1,1 Date/By: • 13125 SW Hall Blvd.,Tigard,OR 97223 APR 1 2015 Plan Revie Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING D Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST - Mechanical permit fees*are based on the value of the work ❑New construction igAddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ,l-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 �7 Job site address: I 1 70 0 SIA) -P-044.- - S-. Furnace 100,000 BTU(ducts/vents) , 46.75 . City/State/ZIP: I k evy../j bit '9-27-3 Furnace 100,000+BTU(ducts/vents) 54.91 t Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/diredions to job site: 113 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: W a,, Gtirkk Lot no.: 1 Other: 23.32 Other fuel appliances: Tax map/parcel no.: 7 10) A-c. 0 1 S DV Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 r� Flue vent for water heater or gas L 'h�71^ OAP- LLw 7 0(4. j 3 14TerVV S , 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 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: 1)a,u1, N • Range hood/other kitchen Address: _ (� 1 ` ' equipment 33.39 �y�� � I Y>,,, i-, L W .. Clothes dryer exhaust 33.39 City/State/ZIP: c{( 1�� up_ OI -31 Single-duct exhaust(bathrooms, 1` 1 �/ / 111"�� toilet compartments,utility rooms) 23.32 Phone:(W) 33 Z 3 0..1-7 4--- Fax:( ) Attic/crawlspace fans , 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: if V di a1� S Other: A MECHANICAL PERMIT FEES* Address: $ it 0V'"+-5-- -1 2 5 Subtotal City/State/ZIP: FJ,,r Q 1e— q-9"VD Y Minimum permit fee($90.00) /"`"'� l Plan review(25%of permit fee) Phone:(51-(/) I Fax:( ) State surcharge(12%of permit fee) CCB lie.: .--+_C 033 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: l J / * Fee methodology set by Tri-County Building Industry Service Board Print name t7 � Date: ( / I:\Building\ermits\4EC_PermitApp_040113.doc 440-46171(1 I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 • Plumbing Permit Applicati0R1\ECEIVEP Building Fixtures 11111 111 1 1( 1 1 NI 11.I , City of Tigard C� Received S Permit No.:j� �� APR 2 15 Date/By: f /S 1� Y.S-o NI • 13125 SW Hall Blvd.,Tigard,OR 9722., Plan Review • ' Phone: 503.718.2439 Fax: 503.598.1Y1 I�/OF I r` Other Permit No.: Inspection Line: 503.639.4175 IGARD Date X1 Ready/By:WARD / ■ Date ReadyBy: Juris ® See Page 2 for Internet: www.tigard-or.gov TT��DIN D1VISIO� Notified/Method: 1 Supplemental Information TYPE OF W ]ttlj(jJef�tl f FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total XAddition/alterdion/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 X1-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: l 1 'LvO �W �-rv�. Catch basin or area drain 18.76 City/State/ZIP: M 0 1� 'T +2Z Doting leach line,or trench drain 18.76 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: a3 it 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: W 4 ,--- , I Lot no.: Fixture or item: Tax map/parcel no.:2 51 o5 0 t u Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 kr ` � vy 3 � . Clothes hesher 1 25.02 t,�� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 IA PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Nix) i �, Fixture/sewer cap 25.02 Address: N C. W Floor drain/floor sink/hub 25.02 / Garbage disposal 25.02 City/State/ZIP: `V5.,.tk 14/ T-479-1 Hose bib 25.02 Phone:(5 t)3) 33 2_3 t 3--1.1- Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 1 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet ` 25.02 Water heater 37.52 Business name: 4,4/1"\-\°%. 1)11.4 w/ 1!° ) Water piping/DW V 56.29 Address: F 29 '1 5 f t Other: 25.02 City/State/ZIP: C "+ ' `� -p87 Subtotal Phone:013 r2-"2 2-i Fax:( ) Minimum permit fee: $72.50 CCB Lic.: ( 0 s / Plumbing Lic.no.:,240.-5-0 Po Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: 'J a,V'1 6 n t2)-3.41. Date: (.--/.c 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\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1"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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $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 P 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 ❑ Any new commercial building with water service 2"and Baptistry/Font 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 Each Stall 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 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal _ Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 ifi City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT T I GA RD Building Permit Review — Residential Building Permit #: -r,A0ic—G `/g Site Address: 1 + jp Sw f-c 0 r►e� S +' Project Name: / Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: / cikA ti 0 rl 0 (-- l nd o-a ci not. act On rooms g x 7 -1"n d'tvt, 0 (- ) (Verify site address/suite#exists and active in permit system. - Diver Terrace Plan District ❑ Yes v No Site Plan Elements: Three(3)copies of site plan RiExisting structures on site )`ite plan must b g on 8-1/2"x 11"or 11 x 17"paper ptootprint of new structure(including decks)with finished Arawn to scale(standard architect or engineer scale) floor elevations allorth arrow ❑Utility locations(required for new,may apply for additions) WiSite address,project or subdivision name and lot number ❑Location of wells/septic systems Applicant information(name and phone number) ❑Erosion control(including drainage-way protection,silt fence tot dimensions and building setback dimensions design,location of catch basin,etc.) %Lot area,building coverage area,percentage of coverage and ❑Street names impervious area(applicable if R-7,R-12,R-25&R-40)9.5 ❑Street tree size,type and location •' l operty corner elevations(2 foot contour lines if more than ❑Existing trees to be retained with drip line,and tree 4 foot differential) protection measures $Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No — Public Facilities Improvement(PFI)Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake $Land Use Case#: Zoning. a 4.S gr Setbacks: Front 2,0 Rear 15 Side S Street Side 1 S Garage ZQ $Landscape Requirement: - "Lot Coverage Maximum: Building Height: Maximum Height 3 0 Actual Height 2 1 0 Visual Clearance ...a—Easements ensitive Lands: ❑ Yes ❑ No Type —B—iTrban Forestry Plan ❑ Conditions"Met"prior to issuance of building permit Notes: Approved By Planning: Or)O V i e_ (i ) o Date: '//1 / ( S Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved IRevision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw_RES_031015.docx Building Permit Submittal Original Submittal Date: / / Site Plans: # Building Plans: # Building Permit#: i Enter building permit#above. �� ,� Workflow Routing. %Planning ]gineering [ Permit Coordinator Dic lding Workflow Sign-off: .O,�AS' 'i-off for Planning(include notes from planning review) Route Application Documents: ..2 Engineering. (1) copy of permit application, (1) site plan, (1)building plan and ..53...eginal plan review routing form. uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: • Jr Date: //5----- Engineering Review ❑ Slope at building pad: ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes El No ❑ NOT Approved by Engineering: Date: Notes: 1J 4 -''i G R. ) 5 S c../.-.W Approved by Engineering: ,� , Date: 4 / I Z Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions"Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: ColeiK to Issue Permit J y / Date: �/ r S Approved by Permit Coordinator: I:\Building\Forms\BldgPermitRvw_RES_031015.docx 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 IN . Transmittal Letter 1 & n 1. 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 1 lr-Y►(\_ DATE RE f.9 ' ,f'WED DEPT: BUILDING DIVISION MAR 2 ?1J17 FROM: Ip b in Q n j CI U 'OF I' kO COMPANY: BUILDING DIVISION' PHONE: ( 408' 3 6 g 073 7 1,3y.....),e,_ RE: 112° d $ ') FOtiher S` ) Tjcrc1; q72- T ` z--- (Site Address) (Yermtt Number) WAU/t y ' L-.- 1\iLet : D rn S 7a:CA — azrz °)' 1 (Project 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): A KEMARKS Y, Mr. .J al) s- c. , �.,` ,o....P S-,.1) ,,--in„ Po—sk.0, III FOR OFFICE USE ONLY Routed to Permit Technician: Date: 3 a.— l Initials: ii Fees Due: X Yes ❑No Fee Description: Amount Due: . ,C br laic rc,‘/: qA,/ $ 4.3- $ $ $ Special Instructions: Reprint Permit(per PE): ❑Yes ❑No E Done Applicant Notified: bkit....., Date: 314/1 Initials: I:\BuildineForms\TransmittalLetter-Revisions_061316.doc 1 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. DEVELOPMENT City of Tigard • COMMUNITYL PMENT DEPARTMENT 711 a Transmittal Letter TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: G DATE i 'st )< �,'�` ED DEPT: BUILDING DIVISION JUL 26 2018 46i CITY OF TIGARD FROM: hl BUILDING DIVISION COMPANY: PHONE: (flu L`) BY: RE: /l o LJ % 0111i/e.,,r P? TOd i - r (Site Address) '` it Number) • (Project name or subdivision name and lot number) " ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: C.pies: 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): 3T - y't JQ j ci 8' REMARKS: 4 57:71)^r ``" ' t./> // kC trt r_„-1.Ir 4 1) 5 ye1,,,,v,. s-r-.4L\ 6c)C-1 FOR OFFICE USE ONLY Routed to Permit Te' sician: Date: "7/ /jf Initials: /;9/1- Fees ;9j9 Fees Due: ❑ Ye! P1 No Fee Description: Ain- Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes 010 ❑ Done Applicant Notified: Date: 7/n,/i( Initials: I:\Building\Forms\TransmittalLetter-Revisions_061316.doc