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Permit
�� CITY OF TIGARD MASTER PERMIT IIII 8 • COMMUNITY DEVELOPMENT Permit#: MST2015-00053 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2015 Parcel: 2S104CA00400 Jurisdiction: Tigard Site address: 13403 SW ESSEX DR Subdivision: HILLSHIRE Lot: 4 Project: WERNER Project Description: Adding a kitchen, bathroom and partition walls for a new accessory residential unit. BUILDING Floor Areas Roauired Setbacks Required Stories: 0 Bedrooms: 1 First: 0 sf Basement: 384 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 2 Third: 0 sf Right: 0 Detectors: Yes Total: 384 sf Value: $22,686.72 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2 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-3 384 Owner: Contractor: WERNER,H JON&BETH Z OWNER Required Items and Reports(Conditions) 13403 SW ESSEX DR JON&BETH WERNER TIGARD,OR 97223 13403 SW ESSEX DR TIGARD,OR 97223 PHONE: PHONE: FAX: Total Fees: $1,568.24 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ap• able 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 •=nded for more the 180 days. ATTENTION: Oregon law requires you to follow th • •••ted by the Oregon Utility Notification Center. Those re set forth in OAR 952-001-0010 through OAR 952-001-0090. Y m copy• •-rules or•. -ct questions to OUNC by calling 503.23 ,� 7••r 1.:00. �.,��t Issued By: L.r_i�_ �i�'!' •ermittee Signature: //�:fil / C-'11't's 5 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 o nr•roject. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential 1.(11Z (H IIt F I • 1 ()\I City of Tigard �\\15) peed /VMS= Permit No.: J'P CS--E3tJc�i� 11111 I • 13125 SW Hall Blvd.,Tigar V Plan Ravi' i Phone: 503.718.2439 Fax: 1960 Q�� Date/B : Ar Lp 'a�� Other Permit: l`h Inspection Line: 503.639.4175 pQ 1 Z Date Ready: tits,/ )ur n ® See Page 2 for Internet: www.tigard-or.gov A` " QD Notified/Method: /S 4y7 le & Supplemental Information �GP .. . - q• ,d Ltc h/.P-J00 TYPE (ii➢ *' GO I REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 13 • 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. ❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation:221036,7.3_,....6,11Z25 ❑Accessory building ❑Multi-family Number of bedrooms: El Master builder ID Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 34103 ).E/1/ . 55 ex viz New dwelling area:"...OA-2- - < n�e feet City/State/ZIP: 'P;6 A IZ D , OR q ( ZZ 9 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: lh/5,o z 4 j(.) Covered porch area square feet Cross street/directions to job site: i 3 5'14 /,/volmir vol/U Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 14 1 VL5 N/Rg Lot no.: 4 Permit fees*are based on the value of the work performed. Tax map/parcel no.: 25 1 oil eA /r4' 001,00 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK,'I /� -r work indicated on this application. A PP k rreiIV 4 / A,✓RAV ?rtr17fO!" Valuation: $ ,t/1A its At 0 Existing building area square feet ,/ 0 New building area: square feet Q PROPERTY WNER I ❑ TENANT Number of stories: Name: JON '5isItl WEeMgte. Type of construction: Address: I q a 3 5(4/ j s x • Occupancy groups: City/State/ZIP: 1/CARD f Oi_ 4/Z ..3 Existing: Phone:(✓ 7()>r - sits-z. Fax:( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: c (Please refer to fee se rk) v�f1r. As 44 Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: Phone:( ) Fax::( ) Amount received: E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES' CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: D G��� t! „ter) Submit two(2)sets of roof plan with connection details J and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review S180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: //'D , fr44 A,✓/�✓"-- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nt/2_ Date: 3- 3(,i- II. *Fee methodology set by Tri-County Building Industry l Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLI (-- City of Tigard Received Permit No III 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TI(;API) 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ titcd n.■,..1 Internet: www.tigard-or.gov ❑ Other i THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW )es 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 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state —Cr ❑ ❑— 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. 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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application 1.0R OH l( I I til O\I 1 City of Tigard Received � DateB r 1111 _• / 13125 SW Hall Blvd.,Tigard,OR 97223 1\��+ Plan Review Phone: 503.718.2439 Fax: 503.598.1 GCE V v® Defeat : Related Permit#: Inspection Line: 503.639.4175 E Ready Date/By: luris: El See Page 2 for I It. RI) Internet: www.tigard-or.gov 0.2 201 Notified/Method: Supplemental Information TYPE OF WORK NI t` PLAN REVIEW . ❑New construction ❑Addition/alteration/M , S1ON Please check all that apply(submit a sets of plans w/items checked): GplVl ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: RUI 11\1 where the available fault current ❑Marinas and boatyards. _ _ _ CATEGORY OF CONS�I el eTION , exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural Multi-family Master builder Other: amps for all other installations. buildings. ❑ y ❑ ❑ ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION . ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address:f 3 Q 5t,' es f 1 X D,2 100HP or more. ❑°A","E","l-2","1-3", / City/State/ZIP: 77(* 0 4„ 'Z ❑Six or more residential units. occupancy. Z ❑Health-care facilities. ❑Recreational vehicle parks. /� ❑Hazardous locations. ❑Supply voltage for more than Suite/bldg./apt.#: Project name: ( /�� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 13 5.44./WA t.Ai VT FEE SCHEDULE Description I Qty. I Each I Total I " New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK • --. Limited energy,residential •p 1" Neh) 60 0 CA/ G r`fiLie/Pa. To I f'// PAD (with above sq.ft.) 75.00 2 Limited energy,mufti-family 75.00 2 1 4/P447 ',y . �- /$v( ,(,►C7 1(,: residential(with above sq.ft.) ff" I El Renewable Energy ❑ See Page 2 Er PROPER OWNER 1,�' Services or feeders installation,alteration,and/or relocation Name: 40 r/ I j�i/ y f/f A,l 1:R.. 200 amps or less 100.70 2 Address: I l' Q 3 S6i 653 5) pl• 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 _ 2 City/State/ZIP: -r'OAP/ OA '7Z 1 601 amps to 1,000 amps 301.04 2 Phone:(503) 10,E -• S y 'L Fax:( ) Over 1,000 amps or volts 552.26 2 `� Temporary services or feeders installation,alteration,and/or J Email: e AV to .j cA/d� - - relocation Owner installation:This ins • ation is .-' •I made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,re• •t- chan• _�'. t ing to ORS 447,449,670 and 701 201 amps to 400 amps 125.08 2 Owner signature: '� i Date: /' 7- �y 401 amps to 599 amps 168.54 2 ❑ APPLIC.e 1 ❑ CONTACT PERSON ' Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first U 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: C f '1 I �}�/.A Sign or outline lighting 67.84 . 2 l�� Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. g City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90,00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: , specifically listed(/z hr min) ELECTRICAL.PERMIT FEES • Suprv.Electrician signature,required: Subtotal: Print name: ;'. Date: ❑Plan Review Required(25%of permit fee): • �/��/_ State surcharge(12%of permit fee): Authorized signature: 2'+/yY`�` TOTAL PERMIT FEE: /� This permit application expires if a permit is not obtained within 180 Print name: l'/, .f'i �.L' eitit c� Date: 5/ 7. C) days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB 1 Electrical Permit Application—City of Tigard Page 2—Supplemental Information • Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE • Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total Rene I y Renewaable electrical energy systems: Check Type of Work Involved: 5 kva orless 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(%]hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): * Number of inspections allowed per permit.(SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 Mechanical Permit Application colt OI I Ic t: 1 511 ON 1.1 City of Tigard Received Permit No.:77-157--; a S•-t1 , ;. • 13125 SW Hall Blvd.,Tigard,OR 97223 - �,�'Ian Review Phone: 503.718.2439 Fax: 503.598.1960 `� DateBy: Other Permit: T I c;.1 It I Inspection Line: 503.639.4175 Ge Date Ready/By: Juris: 65 See Page 2 for Internet: www.tigard-or.gov R LO, Notified/Method: Supplemental Information TYPE OF WORK �Q� GPP�ea COMMERCIAL FEE* SCHEDULE - USE CHECKLIST �F I`\ S Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alteration/replac0 ►eOt\NG, performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: °\\. mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. El Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: kr SS ,f Air conditioning 46.75 _ Job site address: i�/f 03 5W F. X lie, Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: f/174 j7 0g, 1112.7 3 Furnace 100,000+BTU(ducts/vents) , 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: wEiz wk Duct work / 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above '_ 23.32 Other: 23.32 Subdivision: Lot no.: - Other fuel appliances: Tax map/parcel no.: Water heater / 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 �! ,_ ! �p� �^ Flue vent for water heater or gas Zet0 N 1.,'�����/h�/�et i -/IV l' de-Ar'/ e1 4 ta- /"'- 7 - r/oct fireplace 23.32 1NSTAt.t. /Yal• 50Pf E'V`r,ff r ,/t✓ N744L�rN Y Log lighter(gas) 23.32 y'y aft"-, ` Wood/pellet stove 33.39 EkiIQV T vrtV75 era Dq Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 El'PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: .50 4/ t ' t'T 1 W f tz Nf ec Range hood/other kitchen r Address: f '103 (4,i i 5c6)( Yl4, Clothes dryer / 3.39 Clothes dryer exhaust _ 33.39 City/State/ZIP: 17 Gj f gp / 02- 43 7 ''I Single-duct exhaust(bathrooms, toilet compartments,utility rooms) _ 23.32 Phone:(503) 7L/('• - `/(s1- Fax:( ) Attic/crawlspace fans _ 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater , City/State/ZIP: Water heater I Phone:( ) Fax: :( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) , Business name: V /0 Other MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) . - Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: 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: F U ��l�i 4(•�� * Fee methodology set by Tri-County Building Industry Service Board Print name: ti -j. gitk 1147.- Date: q. 7 • iS F.\Buildingl PermitsVMEC_PermitApp_040113.doe 440-4617r(I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\Building\Permits\MEC_PermitApp_040113.doc 2 Plumbink Permit Application Building Fixtures \IcD Ft)R tlrFlcl: l ti l: f)�I.1 City of Tigard G�`v G Da eBy: Pern .��S 11‘ I • 13125 SW Hall Blvd.,Tigard,OR ^ + Plan Review Phone: 503.718.2439 Fax: 503. 98.1960 t` LO 1S Date/By: Other Permit No.:ct Inspection Line: 503.639.4175 p Date Read B Juris T I G A R D p NY ^QD Y y See Page 2 for Internet: www.tigard-or.gov a Gcsa- 1, Notified/Method: Supplemental Information TYPE OF WOR�i`',�Y C'D,v,s10 + FEE* SCHEDULE ❑New construction (S,Dfit on For special information use checklist Description 1 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 312.70 ❑ 1-and 2-family dwelling El 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 3 tic; 541 $c5e k op. Catch basin or area drain 18.76 /l�b^ /'� Drywell,leach line,or trench drain 18.76 City/State/ZIP: l N ! G 177 2'3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: tvgRAI g., Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 - Water service(no.linear IL: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK '`I Backwater valve 12.51 49D 'e, 'T N NC. 74111--E TI s/JUk ?(/6,IIC't,( Clothes washer 25.02 / ^A�l /I ST/ 1 l`t f Dishwasher ` 25.02 ADD �.�PM/t1 /t�'e'l lV ili) (i RAY 0C))j Drinking fountain J 25.02 ,©i /cl TO 01:14 5t Aik- l Ejectors/sump 25.02 RI/PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: f olv t5 gT N V✓m Fixture/sewer cap 25.02 1�Ll C 514/.'/ SS [) Floor drain/floor sink/hub 25.02 Address: �/? Garbage disposal C 25.02 City/State/ZIP: G giR-D r G/ '3 7 6 Z' Hose bib 25.02 Phone:(593) 100. sy5.Z- Fax:( ) Ice maker / 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan / 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 � 1 (1-:- Water heater J 37.52 Business name: 0 l /v€ Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 e Plan review (25%of permit fee) CCB Lic.: P .�bing Lic.no.: State surcharge(12%of permit fee) C Authorized signature: �� � TOTAL PERMIT FEE Print name: /./, d N i ve-2- Date: /j This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\ermits\PLMU-PermitApp.doe 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 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 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 -Drive Stall as defined in OAR918-780-0040. El Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher. -Commercial ❑ Any multipurpose fire sprinkler system. -Domestic El Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar non-food related -Bradley -Com/Serv/Util food related _ -Service *Note: If the fixture work under this permit results in an Swimming Pool Filtr increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard 71 ■ COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: 44S7 7. 20/c7- C W5 3 Site Address: /3d,/Q3 .31) E seX >�Z -- Project Name: iii r- /19( SSn ,�igiceM Ot f-. Lot #: (New dwelling=subdivision name. dition or Alteration=last name of owner) Planning Review / / � /' Proposal: 4/f /fil e, )r A.J e r-4-- i, ,/i 7 4(3 n et-i // , ,-a i l A •. Ai /Vr ∎ a) _ _ • AwArL' Verify site address/suite# exists and active in permit sysstyn. ever Terrace Plan District: ❑ Yes LH No Site Plan Elements: Three(3)copies of site plan Existing structures on site Site plan must bg on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure (including decks)with finished Drawn to scale (standard architect or engineer scale) floor elevations \ North arrow Utility locations(required for new,may apply for additions) Site address,project or subdivision name and lot number Its0 Location of wells/septic systems Applicant information(name and phone number) Erosion control(including drainage-way protection,silt fence Lot 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) Street tree size,type and location Property corner elevations(2 foot contour lines if more than Existing trees to be retained with drip line,and tree 4 foot differential) protection measures It Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified NIr No Received: ❑ Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified g No Applied For: ❑ Yes ❑ No,stop intake 16_and Use Case #: nk it oX iS= 001-Z I LV Zoning: t -- Setbacks: Front Rear Side Street Side Garage Landscape Requirement: Lot Coverage Maximum: 1 Building Height: Maximum Height Actual Height NVisual Clearance Easements Sensitive Lands: ❑ Yes ❑ No Type Urban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: A/G ' / .,-I '' f%/.' d beaouse e.ark. is cZ j 1 i 11k , • Approved By Planning: • i1 4/1;--/S- Revisions Date: (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Bui Id ingWorms\B I dgPerm itRvw_RE S_031015.docx Building Permit Submittal Original Submittal Date: .11711./r Site Plans: # `ir• Building Plans: # Building Permit#: J'Enter building permit#above. �- Workflow Routing: ,�11ning gineering L'-15. Coordinator ut ding Workflow Sign-off: gn-off for Planning(include notes from planning review) Route Application Documents: L r:ngtneering (1) copy of permit application, (1) site plan, (1) building plan and on 'nal plan review routing form. 2"—Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: _ - Date: W.5-- En_ -eying Review ❑ Slope at 'ding pad: ❑ Conditions ' -t"prior to issuance of building permit A ❑ Easements (encroa.4 ments)per engineering conditions of approva . . plat ❑ Wat: Quality/Quanti acuity: A.sess Water Quality Fee lieu: ❑ Yes III No it) tit sess Water Quantity Fee in i: ❑ Y:. El , v LIDA Facility on lot: • es El No • %' ❑ NOT Approved by Engineerin■ Date: II / Notes: Approved by E :'neering: Date: Revisions . ' er Building Submittal only) Reviewer Date R- ' ion 1: ❑ Approved ❑ Not Approved 'evision 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: ?ROOK to Issue Permit , - "Approved by Permit Coordinator: I Date: .9r//5. 9 r/5. I:\Building\Forms\BIdgPermitRvw_RES_031015.docx 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. 17( or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. I L f/- 1 ( `�� ,k.V k' Print Namn of Permit plicant 1 21/ - , Sig ature f Permit Applicant Date Permit#: SYavr s- ow S3 o F Address: /,3110 3 :S'A) L c c x Dr. `��1• ?� / • Issued by: 6 Date: y/v1;�/ S CI-• This Copy for Permit Offices City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 11 , 2017 at 1 :17:26 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Bath fan to be on timer or de-humidistat with bathing facilities. M1507.4 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 11 , 2017 at 1 :21 :01 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Gfci's in bathroom not working. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 11 , 2017 at 1 :20:25 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Caulk base of water closet. 407.2 No shower pan inspection for mud set pan prior to cover. Remove and replace corrugated Lay piping, piping to have smooth interior finish. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 18, 2017 at 12:18:54 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Water test on shower pan covered prior to inspection appears ok. Other corrections complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 18, 2017 at 12:25:51 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Correction complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 18, 2017 at 12:27:58 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - NoCofO Comments: Trade finals approved. Smoke/ carbon detectors ok. Fall prevention devise installed. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13403 SW ESSEX DR, TIGARD, OR, 97223 October 18, 2017 at 12:23:08 PM Record Type: Record ID: Residential - Master Permit MST2015-00053 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Correction for timer ok. Violation Summary: Inspector Contractor