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Permit
CITY OF TIGARD ELECTRICAL PERMIT `7 '. COMMUNITY DEVELOPMENT Permit#: MST2015-00203 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/10/2015 [t �lFt. Parcel: 2S111DB13000 Jurisdiction: Tigard Site address: 15134 SW 96TH AVE Project: MCNAMEE Subdivision: 1991-034 PARTITION PLAT Lot: 2 Project Description: 520 sq.ft.garage addition.6/21/17 REPRINT to add(1)vent fan. 4/5/18: REPRINT to add(11)branch circuits. Contractor: OWNER . Owner: MCNAMEE, MELVIN C JR&RISA L MELVIN MCNAMEE 15134 SW 96TH AVE 15134 SW 96TH AVE ` V , TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-624-1459 PHONE. FAX: FEES Quantity Description Date Amount 1 ea Building Permit-Additions, 12/10/2015 $423.53 Specifics: Alterations,Demolition 1 Plan Review 11/09/2015 $275.29 Type of Use: SF 1 ea 12%State Surcharge- 12/10/2015 $50.82 Class of Work: ADD Building Type of Const: VB 1 ea DC Provision Review,SF- 12/10/2015 $88.00 Ping Occupancy Grp: S-2 2 ea Info Process/Archiving-Lg 12/10/2015 $4.00 $2.00(over 11x17) 9 ea Info Process/Archiving-Sm 12/10/2015 $4.50 $0.50(up to 11x17) 1 ea Erosion Control 01/12/2016 $80.70 w/Development 1 ea Services or Feeders-200 12/10/2015 $100.70 amps or less Total $1,360.54 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 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 952-001-0010 through OA2-001-00.0. You my^obtain a copy the rules •rect questions to OUNC by calling 503.232.1987 1.800.332.2344. Issued By: '�j Permittee Signature: * Z;ZIC - OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. 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. Electrical Permit Applicatioj '' L L ' 4 FOR OFFICE USG O\L1 City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 s Date/B G Phone: 503.718.2439 Plan Review T I G A R D Inspection Line: 503.639.4175 [ulEmail gaiTigardBuildingPermits Ti 9 w g` Date/B : Related Permit#: err a s iR g_ Ready Date/By: frt i r w tig r Notified/Method: Jury. ® See Page for # tgof + Supplementall Information TYPE OF WORK '4 New construction 0 Addition/alteration/re lacement p Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition ❑Other; 0 Service or feeder 400 amps or more CATEGORY OF CONSTRUCTION where the available fault current 0 MarinasBuildinandovboatyr a dstories. exceeds 10,000 amps at 150 volts or 0 g boatyards. gill-and 2-family dwelling 0 Commercial/industrial0 Floating buildings. a 0 Accessory building less to ground,or exceeds 14,000 ❑Multi-family ❑Commercial-use agricultural 0 Master builderamps for all other installations. 0 Other: buildings. JOB SITE INFORMATION AND LOCATION' 0 Fire pump. 0 Installation rgeto 150 derived or Job#: ❑Emergency system. larger separately Job site address: - • ❑Addition of new motor load of system. i City/State/ZIP: ' 100HP or more. ��io .► occ pan„ 2„ «1 3„ ATIMfaiiiii ❑Six or more residential units. occupancy.. Suite/bldg./apt.#: ❑Health-care facilities. 0 Recreational vehicle parks. Project name: 0 Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal. FEE SCHEDULE Descri.lion Subdivision: Total ii New residential single-or multi-family dwelling unit. Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft _� .or less 168.54 Ea.add'l 500 sq.ft.or portion 33.92 _0 DESCRIPTION OF WORK Limited energy, ith residential ft ential 75.00 at, Limitwed energyaro ,mu. lti-family IIIII residential with above ..ft. 75.00 -© 0 PROPE rTY 0 ER ❑ TENANT Renewable Ener Name: Services or feeders installation alter tion and/or relocation• c /V 200amps or less '^ 100.70 _© Address: ? • 9' ,, ' t/ 201 amps to 400 amps 133.56 _© City/State/ZIP: ,I -0 0^ 401 amps to 600 amps - t f! , <� 200.34 _© Phone:(# }`, / 601 amps to 1,000 amps 301.04 _Ei Over 1,000 amps or volts - 552.26 _© Temporary services or feeders installation,alteration,and/or Owner installation:This insta ation is being mat on property _ relocation intended for sale,lease,ren or exchange,according to ORS 7,449,670,which nd 701.not 200 amps or to - 59.36 _© El Owner signature:' 4 201 amps to 599 amps 125.08 =© — Date: �- —/� 401 amps to 599 amps ❑ APPLICANT 168.54 0 CONTACT PERSON Branch circuits—new alteration or extension •er .anel Business name: A.Fee for branch circuits with IContabove service or feeder fee, act name: each branch circuit 7.42 .© Address: B.Fee for branch circuits without service or feeder fee,firstra City/State/ZIP: branch circuit 56.18 Each add'1 branch circuit mg 7.42 —© Phone:( ) Miscellaneous(service or feeder not included Each manufactured or modular ■ dwellin service and/or feeder 67.84 © CONTRACTOR Reconnect only 1111 67.84 _© mg —U Business name: Pump or irrigation circle 67.84 Sign or outline lighting 1111 67.84 —© Address: Signal circuit(s)or limited-energy City/State/ZIP: .anel,alteration,or extension. See Page 2 -© Each additional ins.ection over allowable in an of the above Phone:( ) Additional inspection(1 hr min) 111166.25/hr _■ Investigation(1 hr min) 1111 90.00/hr _■ Industrial plant(1 hr min) - 78.18/hr _■ CCB Lic.: Inspections for which no fee is III' 'A Suprv.Lic.: a.-cificall listed hr min 90.00/hr -. �' Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Print name: Subtotal:Date: - ❑Plan Review Required(25%of permit fee): Authorized signature: State surcharge(12%of permit fee): TOTAL PERMIT FEE: MIMI This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. I:\Buildingermits\ELC_PennitApp_ELR_ERE.doc Rev 10/26/2017 * Number of inspections allowed per permit. \P ...�....., 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: iEt , : FEE SCH�E�D.�i r. r . aaa11� Total RESIDENTIAL offl ONLY Descri tion �4a� sa Fee for all residential systems combined: $75.00 Renewable electrical energy systems: kva or less 100.70 lj Type of Work Involved: 133.56 _ Check 5.01 to 15 kva FM 15.01 to 25 kva IIII200.34 _ • Audio and Stereo Systems* 13 Wind veneration s stems in exce=25 kva: O 25.01 to 50 kva 301.04 III Burglar Alarm 50.01 to 100 kva - 552.26 _II ❑ >100 kva(fee in accordance 1111552.26 © Garage Door Opener* with OAR 918-309-0040 ❑ Solar generation systems in excess of 25 kva: Heating,Ventilation and Air Conditioning 7 az System* Each additional kva over 25 III>100 kva—no additional chargeIII 0.0 _ Vacuum Systems* II Each additional ins•ection over a�able in an of the above:: Each additional inspection is 66.25/hr - [] Other: charledat an how] 1 hr min ■ . Inspections for which no fee is 90.00/hr s.ecificall listed(/x hr min FEES .E ; D r ;' Subtotal(Enter on Page 1): Fee for each commercial system: $75.00µ x Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: El Audio and Stereo Systems 0 Boiler Controls 0 Clock Systems 0 Data Telecommunication Installation 0 Fire Alarm Installation ❑ HVAC 0 Instrumentation 0 Intercom and Paging Systems O Landscape Irrigation Control* O Medical O Nurse Calls O Outdoor Landscape Lighting* O Protective Signaling O Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp ELR_ERE.doe Rev 10/26/2017 CITY OF TIGARD . `. � , MASTER PERMIT 2 COMMUNITY DEVELOPMENT Wiz/ / Permit#: MST2015-00203 T[GAB D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/10/2015 Parcel: 25111 DB13000 Jurisdiction: Tigard Site address: 15134 SW 96TH AVE Subdivision: 1991-034 PARTITION PLAT Lot: 2 Project: MCNAMEE Project Description: 520 sq. ft. garage addition. 6/21/17 REPRINT to add (1)vent fan. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 18 Bathrooms: 0 Second: 0 sf Garage: 520 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right 5 Detectors: No Total: 0 sf Value: $22,532.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Drains: 0 Water Lines: 100 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 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: 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB S-2 0 Owner: Contractor: MCNAMEE,MELVIN C JR&RISA L OWNER Required Items and Reports(Conditions) 15134 SW 96TH AVE MELVIN MCNAMEE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 15134 SW 96TH AVE TIGARD,OR 97224 PHONE: PHONE: 503-624-1459 FAX: Total Fees: $1,269.12 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accorda .- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 day . ATTENTION: Oreo -, requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 -001-0010 through O•' e52-00 ..•.. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I sued By: `/elt / J.i. -., -. Permittee Signature: Xr7 C7/ 47(`G'�.-` Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Applic .,, �� � ," FORoFHlce USEoNt_l City of Tigard :' Received a/ 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ,r Permit No.. /'�/5—�D rl,., ' I Phone: 503.718.2439 Fax: 503.598.1960 Plan Review air/ T I G A k D Inspection Line: 503.639.4175 i i•j;:`t` C i r o r/ Date/By: Other Permit: Internet: www.tigard-or.gov Date Ready/By: furls: H See Page 2 for Notified/Method: Supplemental Information TYPE I•,It:., CIVISION COMMERCIAL FEE* SCHEDULE --USE CHECKLIST ❑New construction 0 Addition/alteration/replacement DIVISION l Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty, I Ea. I Total JOB SITE INFORMATION AND<LOCATION Heating/cooling: Job site address: /(j 3 " 6.10 O f 75-r y C" AirFurnace conditioning0 , 46.75 ( /K� /l ��`- 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: t'l q .7 f') 0 ,/ 9 7 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: 879`/5� /T 1/ d OS 1`..- Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: I Lot no.: Other: 23.32 Tax map/parcel no.: Other fuel appliances: Water heater 4# ,q. of r. , 23.32 . . . "` '; Gas frreplace/insert S p ,([' ' "-- �' '" Flue vent for water heater or gas 33.39 84_y 4L e 4c),c�j fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 n �� �� Wood fireplace/insert 23.32 ,H ac/ 5 (o 3 Chimney/liner/flue/vent 23.32 .4t< O 4 ,' @ ) -* , ` . ""r x Other: 1K v 23.32 Name: /�/� / Vizi %r Environmental exhaust and ventilation: " t EL v j zir C A//¢ Range hood/other kitchen Address: / s-----/ 3 r S l�,.�1/ ?g /Lily_` 0 equipment 33.39 ` Clothes dryer exhaust 33.39 City/State/ZIP: f7 t - OA 9 7^�51 Single-duct exhaust(bathrooms, Phone:(�Q 4:0/:m / ( ) 7 �[ toilet compartments,utility rooms) / 23.32 13 1 j, Fax Attic/crawlspace fans 23.32 0 Other: 23.32 Business name: 4s-y✓v . S Fuel piping: Contact name: $14.15 for first four;$4.03 for each additional Furnace,etc. Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) I Fax::( ) Fireplace E-mail: Range :, wx Barbecue• "r . ,CNTRAC OR X t , � ,,i,, ***a,* , Clothes dryer(gas) Business name: Other: Address: ''' ' CHANiCAL' ERMIT EF S*' x* '' I Subtotal 9-co City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) I Fax:( ) CCB lic.: State surcharge(12%of permit fee) /o, �v TOTAL PERMIT FEE /00. K This permit application expires if a permit is not obtained within 180 Authorized signature:( C //e C� /� days after it has been accepted as complete. / /` * Fee methodology set by Tri-County Building Industry Service Board Print name: EL,6 d t.Jl c, 77 te: 6 ` Q m.._/ I:\Building\Permits\MEC_PermitApp_040113.doc -440-4617T(11/02/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 in CITY OF TIGARD MASTER PERMIT 4II -- 33 • COMMUNITY DEVELOPMENT Permit#: MST2015-00203 T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/10/2015 Parcel: 2S111DB13000 Jurisdiction: Tigard Site address: 15134 SW 96TH AVE Subdivision: 1991-034 PARTITION PLAT Lot: 2 Project: MCNAMEE Project Description: 520 sq.ft. garage addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 18 Bathrooms: 0 Second: 0 sf Garage: 520 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $22,532.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 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: 0 Clothes Dryers: 0 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: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add,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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB S-2 0 Owner: Contractor: MCNAMEE,MELVIN C JR&RISA L OWNER Required Items and Reports(Conditions) 15134 SW 96TH AVE MELVIN MCNAMEE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 15134 SW 96TH AVE TIGARD,OR 97224 PHONE: PHONE: 503-624-1459 FAX: Total Fees: $1,469.12 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 952-001-0010 through OAR 952-001-0090. You may obtain a cop . - . -- - •irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued I Permittee Signature: / )S Cal AFT- if' 75 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. f1/1/15- LS Building Permit Application �� Residential RECE1V FOR OFFICE USE ONLI City of Tigard ReceivedDate/By: rf 5 Permit No./Pi sT'."s___DfJa03 IN 1 4 13125 SW Hall Blvd.,Tigard,OR 97223 9 2015 Plan Review / ddK�JJJJ Phone: 503.718.2439 Fax: 503.598.1960NOv Date/By: I !r{C- / Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: luris: 0 See Page 2 for Internet: www.tigard-or.gov CITY UF.TIGARD Notified/Method: lot Q �S • l Supplemental Information ,,v r.uDING DI'ISI ere lei 4ard TYPE OF WORK REQUIRED DATA: 1-AND 2-FAMILY DWELLING New construction 0 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 0 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: ;190) J! 3/1 f ❑Accessory building ❑Multi-family Number of bedrooms: G' Master builder ❑Other: Number of bathrooms: ' JOB SITE INFORMATION AND LOCATION Total number of floors: I I I% — ar 7 Job site address: / 5/3 Sc.(/?I; r/7L ,,Ug New dwelling area: square feet City/State/ZIP: f-!`9/9,./w OR 9f 7a ay Garag carport area: 6 30 square feet Suite/bldg./apt.no.: Project name: Q A 49 G Covered porch area: square feet Cross ssstreet/directions lto job site: n * v C Deck area: square feet /(9 f# A-x10 5/r [, R Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. OD Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: Q equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. /lv` 1�y e 4 y£ Valuation: $ �7 Existing building area: square feet New building area: square feet Rtf PROPERTY OWNER 0 TENANT Number of stories: Name: A4/5/.. Vide/ C- ( iv A-4,,c£ Type of construction: Address: /&--)3v S C?1 7L, ,, JU i. Occupancy groups: City/State/ZIP: ,&/€€4hD !Q/7 t q1,2-'2y Existing: Phone:(5-04 6•a —19 S-1 Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Stehe ")' `i' 4:1,0(.... Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: 75,,01.€1'2 Phone:( ) Fax: :( ) Amount received: E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: �� � 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. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature:71AThis permit application expires if a permit is not obtained iG 27 .---0-0-0---- within ISO days after it has been accepted as complete. Print name???a 217c 12"„.., Q C Date://.... iS *Fee methodology set by Tri-County Building Industry Service Board. '\ I: Building\Permits\BUP-RESPennnitlA�pp.doc 02,24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY o liyiCity of Tigard Received Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 97223 AssocDate/Biated 0 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical 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 0 0 ❑ 3 Verification of approved plat/lot. 0 0 ❑ 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. ❑ 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 0 9 Erosion control 0 plan 0 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. II 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. 0 ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ ❑ 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 ❑ 0 ❑ architect licensed in Ore:on and shall be shown to be a•s licable to the •ro'ect under review. .II.IZISI)I(' I'IO\; 1. 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". 0 ❑ ❑ 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, 0 ❑ ❑ and protection measures must he drawn to scale and must include the project arhorist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 ❑ ❑ 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. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY Received Cityo Ti and Permit g ��VED Plan Ry: l_`J ' i 13125 SW Hall Blvd.,Tigard,OR Plan Review Phone: 503.718.2439 Fax: 503. Date/By: Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris ® See Page 2 for TIGARI) Internet: www.tigard-or.gov NOV 9 2015 Notified/Method: Supplemental Information TYPE OF W �V ARD PLAN REVIEW t Please check all that apply ❑New construction 0 Addition/al C�pp��pic (�� pp y(submit sets of plans w/items checked): Lily!+',Q'• 0 Service or feeder 400 amps or more 0 Building over three stories. ❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings. 0 1-and 2-family dwelling 0 Commercialiindustrial 0 Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural �pry amps for all other installations. buildings. ElMulti-familylA! Master builder 0 Other: ❑Fireum p p. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived q tL,e_ ❑Addition of new motor load of system. Job#: Job site address: 3 Y g C�/7 I OOHP or more. ❑"A","E","t-2",•'1-s", City/State/ZIP'J /� y /, �y /� ❑Six or more residential units. occupancy. T4�/'r/C!l del /7 aC9 y ❑Ilealth-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: gm��`t ❑I lazardous locations. 0 Supply voltage for more than V`"� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE 96-7414- ��o g 4-t e Description I Qty. I Each I Total I " New residential single-or multi-family dwelling unit. Subdivision: Lot�: Includes attached garage. /3 0 0!1 1 Ea.a ft.or less 168.54 4 Tax map/parcel#: V U d 'd'l I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (with above sq.ft.) �(5-41..9PeWG[a Qiv6 d r,F"r-+1: '1+I- (,/UL-tom.) Limited energy,multi-family 75.00 ,.p_ ! —� residential(with above sq.ft.) Gt WfC �J�� • Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: M 4 L.. AA C /{/4,m tCz. 200 amps or less / 100.70 '_ Address: /Ste'13y CJ Q./`7Lj/G i-p. At fr 201 amps to 400 amps 133.56 7 ` 401 amps to 600 amps 200.34 _2 Ci !State/ZIP: 7( �.�a n !� (f Pamps 2 City/State/ZIP: /9 d r2 601 amps to 1,000 301.04 Phone:(5-03 Gay _'q sl. Fax:( ) Over 1,000 amps or volts 552.26 '_ 7 Temporary services or feeders installation,alteration,and/or Email: 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 exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 0 APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, M� each branch circuit 7.42 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first ( 56.18 2 branch circuit City/State/ZIP: Each add'!branch circuit ( 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: �1 /V'c� Sign or outline lighting 67.84 Signal circuit(s)or limited-energy 0 See Page 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(I hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv. Lie.: specifically listed('G hr min) I ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): / State surcharge(12%of permit fee): Authorized signature: /�� � /a/i� nye.,- TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within ISO Print name( ( l72iA�T e, Date://_9_/c----- days after it has been accepted as complete. ' Number of inspections allowed per permit. t::Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(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 Qt,. Fee for all residential systems combined: $75.00 Each Total �' Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less I00.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n B• urglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n G• arage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ 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: n Each additional inspection is f I Other: charged at an hourly(1 hr min) 66.25/hr I Inspections for which no fee is 90.00/hr specifically listed(Y hr min) COMMERCIAL WORK,ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ri A• udio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n N• urse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1.43eildme\Permits\ELC_PermitApp_ELR_ERE doc Rev 06/17/2015 Plumbing Permit Application `� BuildingFixtures �i� FOR OFFICE USE ONLY (�� Received City of Tigard 15 Date/By: Permit No.: ffl jtc'VC3,Q3 Illi i• 13125 SW Hall Blvd.,Tigard,O 7223 �� Plan Review Phone: 503.718.2439 Fax: 503.598.19 g Other Permit No.: • Date/By: Inspection Line: 503.639.4175 N Date Ready/By: )oris ® See Page 2 for TIGARD k Y Y S Internet: www.tigard-or.gov �u `���?�� Notified/Method: Supplemental Information TYPE OF WORIj,� i��CS`t7 FEE* SCHEDULE v • ❑New construction eYatolition For special information use checklist '% Description 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 El1-and 2-family dwelling E1 Commercial/industrial SFR(2)bath 437.78 1:1Accessory buildin SFR(3)bath • 500.32 g ❑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 c /3 Y S cei 9 6.71# 4--ii . Catch basin or area drain 18.76 `Drywell,leach line,or trench drain 18.76 City/State/ZIP: t-/5 A /� On. 9�a o? Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/diredions to job site: Manholes 18.76 q6 f/ /4!�,e S eM-G f7 Rain drain connector 18.76 �fT t-/ Sanitary sewer(no.linear ft.:__) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: /300o Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 - Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: /N rt. AA C A/A.40 / Fixture/sewer cap 25.02 Address: f.-- /3(/ 5 4 ,7y'' r� `�1/ Floor gedroor sink/hub 25.02 /J `7 441,0 h Garbage disposal 25.02 City/State/ZIP: /g/4/Z2 0 if '17'a 9 C,� Hose bib 25.02 Phone:( ) �7 Fax:( ) / Ice maker 12.51 0 APPLICANT 0 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 l 25.02 Water heater j 37.52 Business name: WaterS�1 in WV 56.29 P�P Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: 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\Pennits\PLMU-PemtitApp.doe 10/01/09 440-4616x(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-15'100' 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 l� 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 ofnormal 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 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 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„ 0 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: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard litr COMMUNITY DEVELOPMENT DEPARTMENT T I(.;ARD Building Permit Review — Residential e Building Permit #: /yj,S7-a6ys,----0 .Z0 Site Address: /S73-2/ C3 j Project Name: /�'1 c p *v . „, _ Lot #: (New dwelling=subdivision nadie;Add(t or Alteration=last name of owner) Planning Review Q / Proposal: P paSar( 11.i'-lt:' e�'1.17GQ S—QQ6 : , ,!? /' ar` L� Verify site address/suite#exists a active in permit syste si p,krer Terrace Neighborhood: 0 Yes U No Si Plan Elements: l� 7htree(3)copies of site plan Existing structures on site o plan must be on 8-1/2"x 11"or 11 x 17"paper II 1.otprint of new structure(including decks)with finished frawn to scale(standard architect or engineer scale) eI oor elevations orth arrow L tiltty locations(required for new,may apply for additions) V§ife address,project or subdivision name and lot number i I i*cation of wells/septic systems l pplicant information(name and phone number) 7 Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions esign,location of catch basin,etc.) gt area,building coverage area,percentage of coverage and Street names impervious area(applicable if R-7,R-12,R-25&R-40) Ill eet tree size,type and location lfi perry corner elevations(2 foot contour lines if more than tri Existing trees to be retained with drip line,and tree 4 foot differential) protection measures 0 Clean Water ervices—Service Provider Letter(lot platted prior to 9/10/1995): •Required: Yes,applicant was notified ❑ No Received: ❑ Yes It/No N\Public Facilities Improvement(PFT) Permit: R,i uired: 0 Yes,applicant was notified 117 No Applied For: ❑ Yes CINo,stop intake 0 ' — and Use Case#: ►, Zoning. /E . our/SSetbacks: Front ,,:-.70 Rear /5 Side S Street Side /S Garage cQO �J(Landscape Requirement: 111 of Coverage Maximum: % ) Irl Building Height: Maximum Height /S Actual Height ID isual Clearance kasements ftensitive Lands: 0 Yes l'No Type 0 krban Forestry Plan (;nditions "Met"prior to issuance of building permit Notes: NeeSI �/ )� /Q& pnoi- �7�'Z` rin /- i SUk.,,'1C12 . 0/e 7Q,1-- S'L� milia Approved By Planning: ------:;a Date: ///94S— Revisions i/ ?//S^Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPennitRvw_RES_0709I 5.docx l Building Permit Submittal / Original Submittal Date: If/ C1 f(� - Site Plans: # r 3 Building Plans: # Building Permit#: #nter building permit#�above. Workflow Routing: [ —Piing Li�Engtneeringermit Coordinator wilding Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: 0.--r gineering: (1) copy of permit application, (1) site plan, (1) building plan and o al plan review routing form. lBuilding. original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: if/q/5-- Engineering Review X 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: 0 Yes ❑ No LIDA Facility on lot: 0 Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: ifi0 Date: // <g-ig- Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 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: ❑ SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: 0 Yes ❑ N/A ►il#:K to Issue Permit Approvedby Permit Coordinator: Zi I Date: //// 9/l-, I:'.Building\Forms\BldgPermitRvw_RES 0709I5.docx I 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 per mits. 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 a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. A--1"-- I will be performing work on property I own, a residence that I reside in, or a residence that I w ill 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. 7rint Name of Permit Applicant "- }77,(-/2/i( 7l'� — l/- 9—/c - Signatuermit Applicant Date Permit#: /1757:220/c -c'O 4,203 ..�. r Address: /5-0 jt-ti �•,♦�' Issued by: % Date: MAO/ic [11•i This Copy for Permit Offices IN City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT N Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor IZI City Staff Check(✓)one REFUND OR Name: , INVOICE TO: (Business or Individual) M G , J? H e i\J A M El., ( -----i—• Mailing Address: 1 S l ,4 L7 iJ- City/State/Zip: —fro,FtQ7j c2 97 2,. .(-1 PhoneNo.: 5O1,"6ac4 - 1ti6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): • ,cANGELIVOID PERMIT APPLICATION. `Y REFUND ERMIT FEES (attach copy of original receipt and provide explanation below). ji tN OT E FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: M6-1-0.9---0 15— ooad-J Site Address or Parcel#: .51 3( o.lt q t.e1.= t]E_- -'1;CoA2'-b oe 97aa Subdivision Name: Lot#: EXPLANATION: oto t� ©JP P. y M O PCP_H i T 1 . — 1 AL PtHDu.►J► o nJ� PNE.rutJ7`__D (4 * 3a6. St . .E-� A-MAeft-M£raT FOIL- aiN LCu t..R n t S A>J. 123Q..E..4 Kyo u.)13 OP- 12.S 3f. ht-S H 0-d-OU Kfr5- • a h /17 Signature: �� .�L �� _, Date: Print Name: 1 0)6 1' j,PsMs ti-N1 Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 800/s of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date it 1-7 y Route to Records: Date 2/2 ie /7 By 4664-- Refund Processed: Date 31A9//7 By pa. Invoice Processed: Date By Permit Canceled: Date /h✓j.." By df' ' Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 92314.doc - N 1,11 TIGARD City of Tigard March 15,2017 Melvin McNamee,Jr. 15134 SW 96th Ave. Tigard, OR 97224 Re: Permit No. MST2015-00203 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 15134 SW 96th Ave. Project Name: McNamee Job No.: N/A Refund: ® Check#224120 in the amount of$381.50. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund overpayment of plumbing and electrical permit fees that were charged for as a new residence rather than as a remodel by fixture count. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefunWigurgVtiggliado'T'yig, rs,/C*gon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov " City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use,development engineering and building permit application fees. Receipts,documentation and the Request for PermitAction form (if applicable)must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Melvin McNamee,Jr. DATE: 3/10/2017 15134 SW 96th Ave. Tigard, OR 97224 REQUESTED BY: Dianna Howse DA TRANSACTION INFORMATION: Receipt#: 401001 Case#: MST2015-00203 Date: 12/10/2015 Address/Parcel: 15134 SW 96th Ave. Pay Method: Check Project Name: McNamee EXPLANATION: Refund overpayment of plumbing and electrical permit fees;applicant was charged as if project were a new SF rather than a remodel by fixture count. k- �es'bn � rn b�e � ' '' � �'z �*� �� �" !?,�£ € °,`�» fd, a� • i�n..i. " �ti t, e Plumbing Permit 230-0000-43101 $212.63 Electrical Permit 220-0000-43103 128.00 12%State Surcharge 100-0000-24001 40.87 TOTAL REFUND: $381.50 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION:USE.ONL . Case Refund Processed: Date: .�Z v, By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 Plum bin2 Permit Application ,,,,, „ .-oi, ,,, , ,„ ,,-,-. , IIIIIIIMm: aimu, Building Fixtures ,,,,-, - ,I t .., ,,, 1 City of Tigard titktReceived .4 13125 SW 11311 Blvd. Tigard,Olt 97223 filit o,',.„ '1',,, ' ' ' oriteipx,, , Permit No.: i 0 „ ....•'7.,..._, L.4.41•11W , l'Ian ituview Phone: 503.718.2439 Fax: 503,598.1960 - Other Pamir No: , ‘4,‘,1 1,ateitty. 1,:.•.'--,''' .. 0 itinprction Line: 503.639.4175 '' , 1 1 ,'' -,N. D410 Ready/By. - rutir RI see Page 2 for Internet: www.tigard-or.gov ••,-- t,i''' , . • Neidiedfmrshd. Su..lemental Information ..., , 0 New construction Ellle ton - Fur vecial fltformalion use checklist Description Qt . Ea. j 'total 0 ,. Additionialteratiottireplacement 0 Other: New 1-24iimily dwellings(includes 10011.for each utility connection) -- S•' '` ' ' CATEGORY OF CONS11111e11111N ' SFR(1)bath 312.70 0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 _„.. _____... SFR(3)bath $00.32 0 Accessory building 0 Multi-family -- . Each additional bath/kitchen 25.02 Master builder 0 Oilier: Fire sprinkler 1sq.II.) Page 2 • - " ' • J011 SITIf. INFOR/41ATIOI4 ANZI>LOGATION. . - ' Site utilities: . , . , ., , , ... „............____ ,„...„._ Catch basin or area drain 18.76 Job site address: /5„, ,/3 CO e i.rt. a * Drywell,leach line,or trench drain 18.76 .City/State/ZIP: 7L79 AA') Cd)//, . q'2 9 54. Footing drain(no.linear II: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 . - . . .. „ Cross street/directions to jobsite: Manholes 18_76 #0 i AiririVW Ac 111" se 71-12L4,e/1" ,o, Rain drain connector 18.76 . _. _._ - - Sanitary sewer(no.linear 11.: 3 Page 2 - Storm sewer(no.linear R.: ) Page 2 --___ Water service(no,linear a.: ) Page 2 Subdivision: -r...mino.: Fixture or item: ____ _..... _ 'fax map/parcel no,: s, /'':? 01::)a Backflow preventer OF:SCRIM , WORK ION OF - - Backwater valve 31.27 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 12.51 `ItOpEETy owNER 0 TENANTExpansion tank .._„Fixture/sewer cap 2.5.02 Name: 4irc,,,,, AA C„/VA, ,e`'44 f,.,4 ... Address: fir•-- /3(if .. zei of_4 Li.-- . ,,,t/.. I'''.'"Iz-f-f Ap- t- Floor drain/floor sirlahob -- Garbage disposal 25,02 25.02 .. City/Suite/ZIP: ./...,/,94./21) 0 re - 7 a 9 Hose bib 25.02 1 Phone:( ) Fax:( ) lee maker 12.51 1 , :-. 1:1 AppLICAlsiT , ,",. . 0,:etyNTAET prEsofit'<, interceptorigrea,se trap 25.02 .. „ , „„.. „„. __......... • Business nameMedical gas(value:$ ) Page 2 : Primer 12.51 Contact name; „ _ Roof drain(commercial) 12.51 Address: Sink/basin/lavatory f 25.02 _ .„ City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) IFax::( ) '1'1lb/shower/shower pan / 12,51 i al....5./ E-mail: ._ _ __ . _.„._ ___„,„„„ Urinal 25.02 --- •- , , , ,, , „, ., , • . . - - Water closet 1 25.02 eQ 5.4!'2" Water heater 37.52 37.5?- Business name: Water piping/DWV 56.29 Address: Other 25.02 City/State/ZIP: Subtotal /00.07 Phone:( ) Fax:( ) Minimuni permit fee: $72,50 Plan review (25%of permit fee)CCB Lie.: Plumbing 1.ic.no,: - • State surcharge(12%of permit fee) /42•01 & Authorized signature: TOTAL PE,RMIl'FEE - Print name: i f./ate: 'This permit application expires if a permit is not obtained within 180 days after it has been accepted 31S complete. *Fee triethodology set by Tri-County"Budding Industry Service Board. I ZuildvngiVertnitssfi.NILLPoltniCAp4,doc 0,'01A,9 44(1-4616T(PY02it,I)MAVEB) Electrical Permit Application . City of Tigard Received Permit i:3v: *r + -e"°,. w11/25SW hall t31vd,.Tigard. )i. � ENED tst Ra•€ew* , Phone 50t18.2439 Fax: Sl3,, welly, Related Permit 8.' inspection Line: 503.639A175 Ready l?arezEly: Ana: .. f 14r 11tt3P e 2 ---intrgatlt eetet ardigartid,rgrw Nov f3 - h7entfi�,d"h9eriod �'s.>� aaasptatrmtn#al Information 0 New construction 0 Addition/al t +" . Nast check all that apply ts`zttamr€'�cera of plans w°iaerrss chcn kcd7 �^ Cletxtcrlititan * �� `z + d� i,J L other ❑Sen ice or feeder 400 a Mph or more 0Building over three stnrits. v ..WN when^Ore available fault current marinas and hoof ards a, - ' '` 4'.c ,,o Qs • �.. c t, .: eac cds 104)00 am sat i5ra odor air ❑ .- P ❑r1omow.buiietinp. 0 1-and"t family(lsvelling 0 Commercial.industrial 0 Accessory building less W ground,err exceeds 14.€1t ❑Commercial-tom aprirnit l Multi-family rmtyc a<+r oil other inytnitatrurc, buildings., } Master builder Q Cither ❑#ira putrrp, 0 ineraltarion of ISO KVA or '' ,t l�' ft �� ll lsi iii4 •ib ,7 „ ❑,,,,,,rp c ,)s}'stern. rht y'rt r ved lrry,o$tria ei Job f#' Job site.lC J 0 Addition or new moan load of system Jdr .�s:/ "/3 ca l c' . lout n or more. 2 ���/ ,�a� ❑ a1 t 7 l t5., City'rStateZlP:r 0, `, rty , .. r« ,.,•�j., ❑SsormorereidcnOelrooks occupancy. Lr C I *5c ❑#lcaitir erre facilities, 0 ttemaadowI.vehicle tanks, Suite/bldg,/apt.4: Project nurrte: it ,4 Ao < ❑1 iavardous loeel oras, 0 Supply voltage Mr more than Cross street/directions to„job site: ❑Ser gat or feeder 600 amps or mon;, 600 8011,aanrnnal y4'. A ,—.J. ni°Cri Oren �` L. Et" t /.�. a j/, _...- L ...�!' L .m ti-LC.- New residential sinle-or�mulil-fanilys �elin u�n�ittet' =W Subdis ision: Loot 4: Includes attached garage. Tax tnslt°}7arcel : 1,t tel ,t1.to less 165.59 : 4 K `s,,,. r fir, r �: P -,«. "�,,..i " ...... .. La add 1 50Mt sq.ftor portion 33,8+2 I „" N-# e � �, �. l rmimd cne"bpv,residential 78,00 2 4 - �^'� y_ {u iah whoa e.: .n ,,l,� 1_.-YT' 0 11 '' I« E't".1 Limited ener y,tttuln family , remdentr al lw ibis above ;lt,t 751111 n Renewable Energy 0 Set Page 2 ' AI O ,,. ! *0;30 8 `i n _4, :, Services or feeders installation,alteration,and/or relocation Name: jit,off" L. A C' i e 2(0€)coups or less / 1(51.70 /MID 2 Address: 1 ---/ _ I ' �'-1 tier. 2u1 aerate to 400 urrl 03;56 ; C ttx Stllte'ZIP. /9 61.#1 '2 - fr 11/Imps to 1,OI 0 amps 3€1.14 ps t r l €lQ St71,t14 2 Phone:(5"q3 _ J`! J F a''s:( ) Liver 1,ot i crisps or soils 552.26 " 2 Email: `' Temporary orary services or feeders instailatiner,alteration,and/or relocation tintener nded for sale,lease,ris tent,e rllation is being made on promty that exchange, to ORS 447,449. wn 670, 70-1 not 23017Mops oro lege; 2 .06 2 according .. amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 1681.5 y 2 %' K,k%.<. -:.!/ '*''A ''''''',44r:-:.v' ''ft, , ; tv,; g ` . f r Brafeb circuits mm ncw,alteratluu,tar exteaasinn.per panel a�.Ttc filer baaiae-b circuitry stir/a Business name: ,Qson abote service or feeder fee. eachbranch circuit 7.42 " Contact name: ,H.Fee for branch circuitsraitTroor Address: service or feeder fee,first 2 branch circuit t . M*1141 - C:°ity;5tdtezZlP: 1,ach told i branch circuit Phone:( ) Miscellaneous(service or feeder not included) r leas:: 3 l,ach ma utaktnrcf urrntxlulUr 67.84 s Email: dwelling,servicnod<ir feeder y Reconnect only' 67.842 .. ✓-. r r, 1Tt �l k ,` ,„; ,. Pump air irrigation circle 67,8 4 Business name'' 2 Criii Sign or outline lighting 67.04 — ..„„,.-.._ ..�, ...--- w Signal circuit(s1 or limircisenor s Address: ❑ Seet lea 2 panel,alteration,or extension, C icy,5t ale! I.P: Each additional inspection over allowable in any of the above Additional inspection(1 hr mini 66.25-hi Phone:( ) Fax:( ) Investigation(1 hr mini 90,0(1;hr Email: Industrial plant(I hr min) 78,10!for ,. Inspections for which no fes,is CCB Lie.: Electrical Lie,: Suprs.Lie.: c ureal€s listed C. hr mini �U l00 ,r Suprv,Electrician signature,required: amide ,ubtotal: I. T Print name: "1Date:• ❑Plan Review Required 125%ofpc mit fee): State surcharge(12%of permit lee): / .7 Authorized sii rtaturc: 4t 2-24,-;‘,..x..,. TOTAL PERMIT FEE /r 9, Ye This permit alrptira#lon Aspires it a pereuit is not obtained within 11W Print nsune; L7aTe: e* �{� �1 to /,... „„,,,„,/,c'-----' dati s atter it has been/caner d as comtylete. #nmlr of ire& tp<arrs al(o t°rxl rC r{fit telt. V.CauStslan„Ptarnfls>til€'Pcvtuit:Yns It 32 ref,t1.... Iter tK 1"',,4I 5 .344-15;ATO t£ei COM t4'Ht City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 15134 SW 96TH AVE, TIGARD, OR, 97224 February 4, 2019 at 2:11 :20 PM Record Type: Record ID: Residential - Master Permit MST2015-00203 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Correction from previous inspection complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 15134 SW 96TH AVE, TIGARD, OR, 97224 February 4, 2019 at 2:11 :20 PM Record Type: Record ID: Residential - Master Permit MST2015-00203 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Correction from previous inspection complete. Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 15134 SW 96TH AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2015-00203 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 15134 SW 96TH AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2015-00203 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 15134 SW 96TH AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2015-00203 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor