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Permit (9) (9TY OF TIGARD MASTER PERMIT ,i �. r' 2 'COMMUNITY DEVELOPMENT /2 l�� Permit#: MST2016-00035 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2016 T[ .�+ `C g Parcel: 2S110BB00100 Jurisdiction: Tigard Site address: 14059 SW 119TH PL Subdivision: None Lot: None Project: Atrium Homes Project Description: Demo existing garage/carport, replace with(3)car garage with living space above. Some remodel of existing residence. 12/06/2016: REPRINT permit to add repair of 75'water service. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 2 Second: 799 sf Garage: 660 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 799 sf Value: $75,000.00 Rear: 20 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 75 Drains: 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: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 18 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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 R-3 799 Owner: Contractor: ATRIUM HOMES ATRIUM HOMES LLC Required Items and Reports(Conditions) 15020 SW 149TH AVE 4616 SW 42ND PL 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97224 PORTLAND,OR 97221 2 Bolts in Concrete special inspection required PHONE: 503-706-4709 PHONE: 503-209-0544 FAX: Total Fees: $3,688.98 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. ATTENTIO • 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 t- ou.h•_R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ___ Issued B . :- Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. // This permit card shall be kept in a conspicuous place on the job site until completion of the pr' ct. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicati Building Fixtures RECEIVES FOR OFFICE 1_SE City of Tigard DEC 6 2016 Received / ��+7 IN13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: l��4: �r• Permit NS/ GJ/� �'�� c II Phone: 503.718.2439 Fax: 503.5trier OF 'T IGARD Plan Review Date/By: Other Permit No.: TI G A R D Inspection Line: 503.639.4175 e /-e mil/�o Internet: www.tigard-or.gov03.63BUILDING iiiI SION DateReady/By: Juris: Fd SeePage2for Notified Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist diq Addition/alteration/replacement 0 Other: Description Qty. I Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) �.. CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 diti_and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION" AND LOCATION. � Site utilities: ✓ Job site address: C\ S\14 ..,c>,\ � Catch basin or area drain 18.76 City/State/ZIP: -\ p 1 E)-C1--- '. -1--)---k‘ 1Zt_ Drywell,leach line,or trench drain 18.76 C . Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: 25) Page 2 ‘0, .Sy Subdivision: Lot no.: Fixture or item: / Tax map/parcel no.: Backflow preventer 31.27 "DES{ ION Backwater valve 12.51 Clothes washer 25.02 /9/j "e E)C/S 2%A/6-> /° /`y/." Dishwasher '1 t=- 1.4 `Gt 9 _ r Se--44,'/e Drinkingfountain 25.02 25.02 Ejectors/sump 25.02 PROPERTY OW11NEItj= -' ❑ TENANT Expansion tank 12.51 Name: C___\ ct.�- Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: \b lkro S \--I~`" 't Garbage disposal 25.02 City/State/ZIP: `?G <\_ ,'j -a- ---4-1-)..___\ Hose bib 25.02 Phone:( 3' 0 cx-t L.1 Fax:( ) Ice maker 12.51 Q APPLICANT" ,0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: Primer 12.51 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 Business name: Water heater 37.52 Water piping/DWV 56.29 Address: Other: /L)/V/Ai fes: ,rift y t t City/State/ZIP: Subtotal //',7.,5 ( Minimum permit fee: $72.50 Phone:( ) Fax:( ) CCB Lic.: Plumfbing Li 410.1 Plan review (25%of permit fee) �. Authorized signature: State surcharge(12%of permit fee) 7,S 0 TOTAL PERMIT FEE //s,0 G/ l� J Print name: P3 , Date:tt.-y 6--2a fo This permit application expires if a permit is not obtained within 180 day/ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: ' Permit Fee: Footing drain-l'100' 50.03 0 to 2,000 $121.90 37.52 2,001 to 3,600 $169.69 Footing drain-each additional 100' 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 Total"" each additional$100.00 or fraction thereof,to Fee,(ea) ., and including$10,000.00. Other Inspections or Fees 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 each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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 engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" . " Isometric or Riser Diagram -' u" 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice MachiRefrig.Drains 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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016 00035 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 '` Date Issued: 04/18/2016 TF +� R g Parcel: 2S110BB00100 Jurisdiction: Tigard Site address: 14059 SW 119TH PL Subdivision: None Lot: None Project: Atrium Homes Project Description: Demo existing garage/carport, replace with(3)car garage with living space above. Some remodel of existing residence. 12/06/2016: REPRINT permit to add repair of 75'water service. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 2 Second: 799 sf Garage: 660 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 799 sf Value: $75,000.00 Rear: 20 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers:,1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 75 Drains: Catch Basins: 0 Bckflw Prevntr: 1 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: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 18 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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 R-3 799 Owner: Contractor: ATRIUM HOMES ATRIUM HOMES LLC Required Items and Reports(Conditions) 15020 SW 149TH AVE 4616 SW 42ND PL 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97224 PORTLAND,OR 97221 2 Bolts in Concrete special inspection required PHONE: 503-706-4709 PHONE: 503-209-0544 FAX: Total Fees: $3,859.65 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- . in a •. of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. i1°W Issued B .��- Mee Signature: —� ►� all 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 projec Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures 4 City of Tigard 1 c„ `i Eiew ' 7/' permitNo.:Illq *4 13125 SW Hall Blvd.,Tigard,OR 97223 pRp "- �C Phone: 503.718.2439 Fax: 503.598.1960 1 `0t(� Other Permit No.: (� `' �y ate/By: T 1 G A K D Inspection Line: 503.639.4175 `,"�� `-'(`,®`V�® Date Ready/By: 7uris: la See Page 2 for Internet: www.tigard-or.gov Q�,` :01°' Notified/Method: ''�'V4, Supplemental Information TYPE OF WORD ey FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description Qty. I Ea. I Total Addition/alteration/replacement 1=1 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) l CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 p 1-and 2-family dwelling 111Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1'L 0.4.;"4 LL \ Catch basin or area drain 18.76 City/State/ZIP: (c 061._ �'- .ZZl\ Drywen(line,or trench drain 1 2 Footingg drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 ,44 ` �Q 1(\ ?\ < C i�tn 4i Rain drain connector 18.76 A 3 _ 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.: Backflow preventer i 31.27 3), )-7 DESCRIPTION OF WORK . Backwater valve 12.51 ° '''' ' Clothes washer 25.02 fj/ & - 7-Lc, ',,,Y.---•1 �� -rt " Dishwasher 25.02 ` 'EZ .t- ' i P-- S -' Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER - ^' ;r t Expansion tank 12.51 Fixture/sewer cap 25.02 Name: c.--CL:s.. C`N -O r,'\.-:',.. ...' Address: Floor drain/floor sink/hub 25.02 b �� ` Garbage disposal 25.02 City/State/ZIP: eO fZ L c:,(---1_ Z-Z` Hose bib 25.02 Phone:( '3Z))‘j .0? ` S Fax:( ) Ice maker 12.51 4V.LICANT 4e ON Interceptor/grease trap 25.02 Business name: f�1? v1/4--k.0 ' - Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: l P d Roof drain(commercial) 12.51 Address: k) Co "P -)__ -""''' Sink/basin/lavatory 25.02 City/State/ZIP: Qo Cl... - �t\-..t-�� DPI_ 91-)"-? 2 ` Solar units(potable water) 62.54 Phone:( 51E) -2,.0-1 05-1i LI Fax::( ) Tub/shower/shower pan 12.51 E-mail: C,t p R._,:‘,1-pi.......v rzs,Afit:i ©o, L.. k"'\ Urinal 25.02 irk' ;_' , - Watercloset25.02 . .t� CONTRAR § , Water heater 37.52 Business name: ...1 E\__17-P. S T ' �L__\`(V\(�'\,!`{ Water piping/DWV 56.29 Address: 1'?2,,c3S SN'Z-- "^I', Other: 25.02 City/State/ZIP:k.- J _ OA_ cc ? Subtotal 3 1,27 Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: g Plumbing Lic.no.: S%o� Plan review (25%of permit fee) State surcharge(12%of permit fee) 3.-76j Authorized signature: ( TOTAL PERMIT FEE 3 5 c 3 Print name: ` C Date:bL 2A. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty Fee(ea) Total Square Footage: Permit Fee: Footing drain-i' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees* Plan Review for Plumbing Installations -,,, Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for - Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font 0 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure -Drive Thru as defined in OAR918-780-0040. ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher Commercial ❑ Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" .1so ...cr Riser,Diagram 4>, ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/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 TIGARDMASTER PERMIT Permit#: MST2016 00035 It' _. ,, COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ' n Date Issued: 04/18/2016 Tt'a.4RL g e Parcel: 2S110BB00100 Jurisdiction: Tigard Site address: 14059 SW 119TH PL Subdivision: None Lot: None Project: Atrium Homes Project Description: Demo existing garage/carport, replace with (3)car garage with living space above. Some remodel of existing residence. 12/06/2016: REPRINT permit to add repair of 75'water service. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height 23 Bathrooms: 2 Second: 799 sf Garage: 660 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 799 sf Value: $75,000.00 Rear: 20 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 75 Drains: Bckflw Prevntr: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 18 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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:Y Square Feet: ADD SF VB R-3 799 Owner: Contractor: ATRIUM HOMES ATRIUM HOMES LLC Required Items and Reports(Conditions) 15020 SW 149TH AVE 4616 SW 42ND PL 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97224 PORTLAND,OR 97221 2 Bolts in Concrete special inspection required PHONE: 503-706-4709 PHONE: 503-209-0544 FAX: Total Fees: $3,824.62 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through•A R 952-001-0090. You ma obtain a _he rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344 Issued By `,rraciirr Permittee Signature: I `r` . 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the prole,/ . Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application .O 12 mil( i ',i OM 1 City of TigardReceived 13125 SW Hall Blvd.,Tigard,OR CE1VEI) Date/By: Pemrit No.:�(7r r .►/__µ�Q Phone: 503.718.2439 Fax: 503.598.1960 Plan Rcview t7�+t(!/-GKJ J Inspection Line: 503.639.4175 Date/$y: Other Permit: Internet: www.tigard-or.gov F'? o r i ' NotiDatefr /Med/Me Bo: Anis: 0 See Page 2 for thod: Supplemental Information N a I _ 1 • t ( Mechanical permit fees"are based on the value of the work 0 New construction is Additi s ° tin rep ace performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑ Other: er mechanical materials, equipment, overhead,,and profit. Value:$4 , ® 1-and 2-family -S AL EQ[iI1'1►t 41T1 dwelling 0 Commercia dustrial i Accessory building Far ❑Multi-family 0 Master build• Description special information use check/w. 0 Other: ? I Qty. � Ea. Total « 4 4 i s rs R'��-` Heating/cooling: Job site address: `�05t C 1 Q (°'%. AirFurnace conditioning, 46.75 -� l J ` ` 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: .j---& A oft_ p,� Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: l Duct pump 61.06 Duct work / 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 \11%.I & � n p iL 2. E ,U Residential boiler(radiator or Y C7*n toet_ 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert / 33.39 33 3.7 3/73/i7 4-i �A C_ S u Pit'? i j 2 fl� Flue vent for water heater or gas rt r:.P�? r/L 'o-[� .�ls(�'S fireplace23.32 p0 cikia. PIE lit, L.t V t Yka 6 53AC,� C2tJ1�il.. (7)74- Log lighter(gas) 23.32 Wood/pellet stove 33.39 3 /41-4.,.l J {" /`' �,' - / { p Wood fireplace/insen 23.32 v/a � l �i �)C C r 111.11' Civ l 'l. ' v Chimney/liner/flue/vent 23.32 itiP PROPERTY OWNER r f j].TariAN'I`" 3 Other: 23.32 I +� (-,1 j`•Y Environmental exhaust and ventilation: Name: pen-Le 4'C o Gi.,/d 1.1,) Jrt3tit (�'( Range hood/other kitchen Address: /5-b� S W / 011 ft( /1,.. e Clothes nt 33.39 33°'',3473/.9/0 QClothes dryer exhaust / 33.39 3"3:10 City/State/ZIP: f?A1L 02. t ?.224 Single-duct exhaust(bathrooms. ( L7 Fax:( ) toilet compartments,utility rooms)1-\- 23.32 Phone: Attic/crawlspace fans 23.32 .'12 APPUCAig'1 © CONTACT PERSON Other: 23.32 Business name: Fuel piping: Contact name: $14.15 for first tour;$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 } ')5 ?3/1.43//1it Barbecue ` Clothes dryer(gas) Business name: k. . . 011ier: Address: �; .r. 1NLCHANICAL�E ' 3 k�� PL Subtotal City/State/ZIP: e ' .L` -Minitalumpaunitlos4004/0)-- GI fr S".Gv Phone:( `y 01.095 LPlan review(25%of permit fee) '7-7- I Fax:( ) State surcharge(12%of permit fee) . 71 CCB lie.: 01.0 6 9 d TOTAL PERMIT FE /3,r 621 This permit applkation expires if a permit is not obtained within 180 Authorized Signature: days after it has been accepted as complete. Fee methodology set by Tri-County Building Industry Service Board I Print name: (it`` .4:41y Date: 0 Z O Ifo I:Building'Pennits•MEC_PermoApp_0401 t3.doc 440-4617r(I 1 02 COM WEB) n CITY OF TIGARD MASTER PERMIT 1111-1 I • - COMMUNITY DEVELOPMENT Permit#: MST2016-00035 TiGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2016 Parcel: 251106600100 Jurisdiction: Tigard Site address: 14059 SW 119TH PL Subdivision: None Lot: None Project: Atrium Homes Project Description: Demo existing garage/carport, replace with(3)car garage with living space above. Some remodel of existing residence. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 2 Second: 799 sf Garage: 660 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 799 sf Value: $75,000.00 Rear 20 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder_ Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 18 Ea add'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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 Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 799 Owner: Contractor: ATRIUM HOMES ARON ELECTRICAL CONSTRUCTION LLC Required Items and Reports(Conditions) 15020 SW 149TH AVE 15704 NE 70TH ST 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97224 VANCOUVER,WA 98682 2 Bolts in Concrete special inspection required PHONE: 503-706-4709 PHONE: 503-516-3139 FAX: 360-882-7978 Total Fees: $3,634.11 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 - • •- ce 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. A NTION: Or-=•n I- •quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-06 -0010 through OAR•• -001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue By: /_, l . �� r' Permittee Signature: , -.1,- - "---_____ Call 503.639.4175 by 7:00 a.m.for the next available inspectio •ate. This permit card shall be kept in a conspicuous place on the job site until completion of the projo• . Approved plans are required on the job site at.the time of each inspection. rBuildinE Permit Application 4 Residential F-01(()Fri( I: I SE 0\1.1 City g of Tigard RECEIVE!) Received A elDate/By: /l rPermit No.: /��^l�Q � �/ ' 13125 SW Hall Blvd.,Tigard,OR 97223 '� Plan Revie Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 4/10 l Other Permit: I I c,..k R i Inspection Line: 503.639.4175 8 21; Date Ready/13y: ,�/ / Jung H See Page 2 for Internet: www.tigard-or.gov Notified/Method: ,�j//'(fQ ��p Supplemental Information all ur ratAgb Ce TY�lJ V s r' .i 1 L JVISIO REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction • Demolition' Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all [8 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Ki 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 57 0 Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: tt.,‘05c.\ S k l;l`k- '- New dwelling area: 499 square feet 1 -! C'9 City/State/ZIP: c c(Zh (DIA_ 9-1-1-2--Lt " Garage/carport area: 6 G Q square feet \l Suite/bldg./apt.no.: Project name: 4.1.►'ljr(lt' //ren..t} Covered porch area !. S"' square feet Cross street/directions to job site: Deck area: 11-(3 +) square feet S i &l 2-We- )- s. .I 119 kc PL Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ (A.6 A- 'S CA(2_ GA 1a- Uk/;RI 1-4\p('1`t6 sC Existing building area square feet 6,,..t ,r-oP New building area: square feet El PROPERTY OWNER 0 TENANT Number of stories: Name: f.•-Z`mak,^ tt"14 S U,L Type of construction: Address: 11/4Sr)-1...0te S + l4c\I.N" Pk- Occupancy groups: City/State/ZIP: -lc�� rfir), GV 2_Z. t Existing: Phone:(5 - c c0 111_09 E.i Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee sche Business name: J� du)) , ^� w‘..\ �o�t-S L.-LC— Structural plan review fee(or deposit): Contact name: c10?(1,` • • cZ-- Address: 1-t 1 b `V.-P -\12-*"9` ?� FLS plan review fee(if applicable): Y T l7 a:•_1/4'— . 0SZ ��1._-1...kTotal fees due upon application: City/State/ZIP: Phone:(bb"S ...1_, C: 045 1.L1 Fax: :( ) Amount received: 596,51 E-mail PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* ��(Zw�(`\..Ktyl`'� �`{1�t-1o�• C��^^ Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Submit two(2)s•is of roof plan with con - ••- I etails Business name: �'�� j� �oS"� S l_LL and fire departmen • cess,alo t •• the 2010 Oregon Address: Z At.‘fl\V...` g‘..--- Solar Installation Speciss.-- ode checklist. City/State/ZIP: os-L. Ck�2_2_1-1Permit Fee • c udes pl. view $180.00 d administrative fe . Phone:( '5 lou 011 tr Fax:(50', ZO(0 62_0 4 State sur. arge(12%of permit fee): $21.60 CCB lic.: )06 g O O Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: y E_54 Date: 02,....C}�Zp/is *Fee Board t by Tri-County Building Industry Service I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling 1.O1i (>FFI( I. I SE: OM1.) City of Tigard Received Permit No.: 11111 I 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: lll� AI:I) 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITENIS ARF REQUIRED FOR PLA REVIEW 1 e No 'Vk 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 0 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. 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- 1:1 ❑ 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ 0 0 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 0 ❑ ❑ 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, 0 0 ❑ 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. ❑ ❑ 0 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- 0 ❑ ❑ 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 ❑ 0 ❑ 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 ❑ ❑ 0 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 ❑ ❑ ❑ 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 Oreton and shall be shown to be a..licable to the .ro'ect under review. .1CRIS1)ICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ 0 ❑ 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, ❑ 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. ]:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) 07/06/2014 01:30AM 3608827978 ARON ELECTRICAL CO PAGE 01/02 Electrical Permit Ann cation , (,,:,, I h I , ., ',\i , ' City of Tigardgi ter: y/2`D .703 13125 SW lull Blvd..Tigard,OR 97223 p :.27/11111111111111= Phone: 503.7182439 Fax 503.598.1960 lill,_: Roland Permit A: Inspection Line: 503.639.4175 Ready Data/Ry: AskInternet www.tigard-or.gov NotiaeNMathod ❑New construction C Addi ion/2.1texat1ice2/rep1acemt Flom check all that apply(eu '1 secs ofplena whams ❑DdmolStion 0 Other: 0 same;or feeder 400 amps Or more 0 Bw15ng over throe stories. __ we the*tellable Balt cut 0 ldwninaa and lanyards gS;' `.--t r. �. .- ,17..--T--7 ': - ; exceeds 10,000 amps et 150 volts or 0 maks bwydmsa. ® 1-and 2-family dwelling 0 Cota mercialrmdustrial 0 Accessory building lento ground,Dr exceeds 14,000 0 Conenerziat-use aenoulturat 0 Multi-faunil 0 Master builder ❑Other: 0�a umfar all oder iostailsdons h tsisgs � _ pump. 0 hta<ell.eow of ISO It VA or �:,. - -...f- z'''-';',T ❑Emergeney system, immix sepwaoely derived Job#: Job site address:14059 Sw 119th Place 0 Addition of new motor load of ambito. 1001-W or mors ❑"A",`E","1-2","1-3", City/State/Z1P:')Tigard Or 0 Scaor mom residential units. occupancy. El Health-cans facilities 0 Rea¢eetienal vehicle pap Su itClbldg./apt.#: Project name:119th remodel El Hazardous locec on. ❑Supply wham br more than 0 Service or feeder 600 am..or mote. 600 votes nosaiwi- Cross street/directions to job site:SW Gaarde and Sw 119th Place oserertbee ,. lath Total New residential Single-Subdivision: l : includes attached arage atniti-i�utaUy dwelling noir. ot# Tax map/parcel# 1,000 sq.II.or less 168.54 1,=. Ea.x'1500 sq.ft.or portion 33,92 1 1-4_-.11-_.:_,._•:L•-=-1-1,-, --- _ - - -- -' Lusted elev.resid:neat lI, !us- At, . f,.. l t _(with above sq.8) .. 75.00 2 at ) LiDlAtad energy,multi-family 75.00 2 residential(with above aq.R) git r: . e'` ar'r;w 7-'-":7•7 , _ > Ramewalge Energy 0 See Pyne 2 r.,r -" ! ;:�.=r ' ,-��.:. .— 1- C:^.�• - , _Services or feeders is taWtiono • n,and/or relocatio a Name:Anima Hoaxes I.LC 200 amps or less L. 100.70 2 X Address:4616 SW 42nd Pince 201 snips to 400 taps 133.56 2 City/State/ZIP:Portland Or 972221 ato amps 30034 2 X401 60 i amps ps to 1,000 amps 301.04 2 Phone:(503)2090544 Fax:(503)2066204 over 1,000 amps or volts 55226 2 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 seeps or less 59.36 1 intended fir sale,lease,rent,or ex-change,according to ORS 447,449,670,and 701. 201 amps to 400 asps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 = ;s+ ^ ` r —SSG r .,._ .-_'' --- Branch dr --skew,alteration,or extemion,per paw �. A.Fee for branch circuits with Business name:Atrium Homes LLC above service or Soder fee, tach branch circuit 7.42 2 Contact name:Cipriani Vena B.-Fee for branch circuits without Address:4616 SW 42nd Place ranch ccircuitor feeder fee,feat b 56.18 2 breach City/State/ZJP:Portland Or 97221 Each add'l Manch circuit 7.42 2 Misodeueoas(service or feeder not included) _ Phone:(503)2090544 Fax::(503)2066204 Each manufactured or modular 67.84 2 Email:atrrlum_bomes(3yahoo.com dwelling,service and/or feeder __ Reconnect only _ 67.84 2 r Ptanp or irrigation cirrle 67.84 2 Busines name: A P.M 6LEc QacAL ea—ks•R u CT i pN LI._C &So or wtline lidos 67.84 2 Address: 1 0 4 K E -7 0 Sri ' sen circuit(s)or amfted;4oa gy 0 See Page 2 2 Panel,alteration,or t�er,sian, City/State/ZIP: v tt 0v\I CR wi(\ 98 bgZ Each additional inspection over allowable Mao of the above Phone (5n)5#(D ^ l Fax: Additional inspection(1 teat atria) 66.25/Ia 3 ' ,C ( `))881 ^'1 Crl g invemBatioe(1 hr mini) 90:00/hr Email: A t?-9 N _E.C e-.,i}4{1)0•c0 M -Industrial plant(1 hr min) 78.18/hr InspecCCB Lie. Electrical Lie.:C. t 2 su l ha: pptis for winch no fee is 90.00/hr R�/ 7 5 i n 5 • ifical listed hr min) Suprv.Electrician signature,required: ullruIIIIIIIIIIIIIII Subtotal: Print name: •j t)$3:F T . \2 0 N Date:ii ( is 16 _ 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit Ebel:: Authorized signature: • TOTAL PERMIT FEE: This weds*peacock's'expires Ifs wait as sot obtained widths 180 Print name: 10 5.y, I- - A-L.,0 M Date: Lt I {8 I t 6 thlys alter it hes beet accepted as complete. a Number of imapwtions allowed per permit. tineitdiesiPa,e5sELCyam5App ELR-fia&doc Rev 06/17/201,3 440,46151111/osleONWEs 07/06/2014 01:30AM 3608827978 ARON ELECTRICAL CO PAGE 02/02 • Electrical Permit Application—City of Tigard Page 2—Supplemental.information Limited Energy Permit Fees: Renewable Energy Permit Fees: Fee for all residential systems combined: $75.00 , ut000Ina Renewable electrical energy systems: Check Type of Work Involved: s kva or less I. 100.70 N© ❑ Audio and Stereo Systems* 5.01 tO 13 kva IM 133.56 _© 15.01 to25 kva 11111 200.34 _© ❑ Burglar Alarm wted:eaeratlon a -.; is excess of kva: Garage Door Opener* 25.01 to so kva 301.04 1111111m3 Er- 50.01 to 100 kva �© >100 kva(fee in aceardente 552.26 © CI Heating,Ventilation and Air Conditioning with OAR 918309-0049-0040 System* Solar generation systems in excess of 25 kva: El Vacuum Systems* Each additional kva over 25 1111 7.42 �© >100 km no additional charge - 0.0 1111111© ❑ Other: Each additional bus -•: a over allowable In an of the above: Each additional imps l bs is111. 66.25/hr —� • •at an Boer 1 bx aimmiremegmansennw ■ oo.oalu Fee for gig commercial system: $75.00 subtotal titer on rage 1) (SEE OAR 918-309-0000) • Number ofimpeede s.uowed per permit Check Type of Work involved: El Audio and Stereo Systems ❑ Boiler Controls (1 Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVA El Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Inrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No Revises re required. Licenses are required for all other installations L\Buitdas1P Init a.C_r nitpep ,doc Aev06J11t2015 Mechanical Permit Application roll 0141(.1. t sh.OyII/.v)111 • pt...0-9,,t/o_azy3 Cl of Tigard• 110E1VEP Received ��I� Permit No.:1 �L��((/� 7 `J g Date/By: 13125 SW Hall Blvd.,Tigard,OR Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Date/By: I I c.;\I:I) Inspection Line: 503.639.4175 FE 8 ) ; Date Ready/By: loris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information . "�°/ -: ii,i• .� ;.'6 -)1 �I C ,.7h`EE* !#.) -4*CI 1�'.z - '-- .;: ---,--`,----5-, - ' j • "` ,,r,`,fl ct - Mechanical permit fees*are based on the value of the work ❑ New construction im Addition a era ion/repiacembdt" performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ r"' in r , "C1 1' OFCOI4S 0 ,,cTIQN A . . 1f , IRE1�Ei�17AEQUIPMENT EQUIPMENT/S�M&, : 4 ® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑ Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total .', h r ;JO$a'. 1I prailAT#‘tJD'I LOCAL ti Heating/cooling: Air conditioning 46.75 Job site address: `kA.0'3'q S k h r L Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: •‘ .s U cs'J-t art_ �--4.-ZLi'l Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or \DV C.. 6iL 2_ S w Aeici PL- 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 A Flue vent for water heater or gas AIM i Vit C— $u P/ `9 B (2,014 a Au fireplace 23.32 Log lighter(gas) 23.32 C-f -0 rp.. P- f/�►E'J'-- Lt V r i�r 6 3DA (9Vg t_ 74Q—Wood/pellet stove 33.39 3 c,44_ G-7 6-12- Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 PROPERTY OWNER IJ TENANT Environmental exhaust and ventilation: Name: 1 k+'fl) ' fli 4-10M iZS Range hood/other kitchen equipment 33.39 Address: I 2,0SLiu I "1 "4 PL Clothes dryer exhaust / 33.39 33.-ST y 0-2 9�,2Z/ Single-duct exhaust(bathrooms, City/State/ZIP: �{!L_ 7 toilet compartments,utility rooms fl- 23.32 Phone:( 510)-• z. 430- Fax:( ) Attic/crawlspace fans 23.32 E APPLICANT 0 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 Phone:( ) Fax: :( ) Fireplace Range E-mail: Barbecue =.0CONTRACTOR „:, Clothes dryer(gas) Li.c �iD M— L-l_�_ Other: Business name: MECHANICAL PERh4ITFE H:* Address: c5-b O Sia ''-i tt-'.• PL Subtotal City/State/ZIP: e\--N` n /l a_— C a�'L` Minimum permit fee($90.00) Phone: U+'� Fax: Plan review(25%of permit fee) (�� S��j ( ) State surcharge(12%of permit fee) CCB lie.: of O 6 9 00 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: * Fee methodology set by Tri-County Building Industry Service Board Print name: (�°ACL Aly t0-Sik— Date: 0 Z 12_ZO 16 I:Building Permits MEC PermitApp_040113.doc 440-4617T(I 102 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$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I: Bui lding\Permits\M EC_PennitApp_0401 13.doc 2 Plumbing Permit Application I uilding Fixtures RECEIVEDReceiv FOR OFFI( F ( SE ()NIA City of Tigard i°• Date/By: , r$ I , / Permit No.: L5�9[[ice3`taiO - , 141 li 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review s ' Phone: 503.718.2439 Fax: 503.5909t41 1 8 ?n,1 S Date/By: Other Permit No.: I I c ,\R I> Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental information z ttta°. `' s . s`. :+:. $1/1:14,1'4g 3::',f,,--,,,;,;'-'1-. kk fi t y E'r`" - - - �"�-'A7��'�.. � �d,:, .,.1:,'a.. x �� R s� �..2'S'� '. u.h,��,� , �.wa. s r. -t.,.,-,uFr��;e.:y: „.,_. -�". �.�, ❑New construction ;'.1111V. I 0 1''. For special information use checklist. Description Qty. I Ea. I Total la Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) `2 1,.1. ..t.,.w� 7 , , w. ,. x . w'R ` r, SFR(I)bath 312.70 p 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 xn * r t *SHEIIV ® Y=. �� i1'I6'tiPtAnobt Site utilities: Job site address: ,L,‘0S-)3N, S 14 Sk'` Zl.D1/4- ze , Catch basin or area drain 18.76 DrCity/State/ZIP: �Z C. , V� 'I �) 211 Footing d ainh line,noe trench drain 1 Page 2 L Footing drain(no.linear ft.:_) 2 Suite/bldg./apt-no.: i Project name: Manufactured home utilities 50.03 Cross street/directions to job site: p /`�'f p /� Manholes 18.76 S kk¢t62../ - 8_ 5va A. Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 ' f I ? . DESCRIPTION �, OR IC , r Backwater valve• 12.51 d `' .. :- - f. ,..4. -5 , '� � `` '��S��` �'� ' '° � � Clothes washer � 25.02 ��1CD� wv Dishwasher _ 25.02 lav elj C..A1L G,itc-(\.Sk , (V'$(`'.o-' c -- 9...1c, 's�V,.(, Drinking fountain 25.02 �� Ejectors/sump 25.02 ' -,6 'F J : ' , •`" f 1-f, tit Expansion tank 12.51 Name: .f.<7-(1,2A j-\ J�p j\.�� Fixture/sewer cap 25.02 � Floor drain/floor sink/hub 25.02 Address: ,513-2_0 s\.9-4 \`'L.\ "" _- Garbage disposal 25.02 City/State/ZIP: me dL '‘' -2Lk Hose bib 25.02 Phone:( 7;:--c,(o 1_,'-Q Fax:( ) Ice maker 12.51 '' ' °°' k', "."70-,0'', ro ;� " ` t 1 ° �L o it i' 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 4- 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/show shower pan.) ( 12.51 E-mail: Urinal 25.02 Gt z *�"»4 e 't ;,..p,114.,,,,.41,_ Water closet 25.02 iiq` , r', ,. '�,., fY¢�'$,Xrk. '..,h':.t"IF I , ;%40 - k° C,p C;'. � w'q • �"`� Water heater 37.52 Business name: j.L i - pc_U(v\i,,jn.t 6 Water piping/DWV 56.29 Address: \Z2pS St I 68�" Other: 25.02 City/State/ZIP: hk��,..t J tit L � e› 49."Oge Subtotal Phone: ( �?y ��a ©6 a� Fax:( ) Minimum permit fee: $72.50 CCB Lie.: 8 z &LIG Plumbing Lic.no.: 5-62_ Plan review (25%of permit tee) State surcharge(12%of permit fee) Authorized signature: O" _.") -2,0((o 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 Permits Pi MU-Per mitApp.doc 10 01 09 440-4616T(10 02COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Sus .ression S stems: yt 1 ;. § ,�%,Sa"- �„ k;�.? ,� ::: • `,t {- ui ,g.. ,.. 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 Sewer- 1st 100' 62.54 3,601 7,200 $233.20 a 7,201 and• eater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 # _,'' rix ,;h Storm&Rain Drain-1st 100' 62.54 i ° ". :-,430,4:4, r. ,_ 4 , p„,,4 0 �^ 4' $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 11each additional$100.00 or fraction thereof,to a�174A,I etr t p .,.4 a _.z. z n r"r. e,`xa. 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 charte-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 char_e-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 char•e 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*. Flain I evie Ffq r phontang Installations`' Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font 0 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive 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- a '_.. sZ-V 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: L:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 .2-/P-a III City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT r 1 Giz I� Building Permit Review — Residential Building Permit #: H/a1-06l Lo- O o O 3 S Site Address: A/ Sr \r'1 i //9j y P/ Project Name: Dir(VriA. / h.e,5 Lot #: (New dwelling= subdivision name;.Addition or Alteration= last name of owner) Planning Review Proposal: Arno ex I's 11-0\I 14/4Jt e' e•af6/ f1ein, jcsC,je c,i,a( /iv()) Sc.".."cv, Verify site address/suite# exists and active in permit system. E River Terrace Neighborhood: ❑ Yes 1Z. No Site Plan Elements: Three(3) copies of site plan xisting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations M 'orth arrow ArUtility locations(required for new,may apply for additions) ite address,project or subdivision name and lot number "`Q4ecation of wells/septic systems ❑Applicant information (name and phone number) "rosion control(including drainage-way protection, silt fence Kot dimensions and building setback dimensions design,location of catch basin,etc.) —rea,building coverage area,percentage of coverage and ❑Street names impervious area(applicable if R-7,R-12,R-25&R-40) ee}TFee size,type and location ❑Property corner elevations (2 foot contour lines if more than B x4sting trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services -Service Provider Letter (lot platted prior to 9/10/1995): /S---00.15 7o Required: KYes,applicant was notified ❑ No Received: Ds-Yes ❑ No ❑ Public Facilities (PFI)Improvement�' ) Permit: Required: ❑ Yes,applicant was notified E No Applied For: E Yes ❑ No,stop intake "a-Zo❑ Land Use Case#: ......- a-Zoning: ning: k— iv, S' Setbacks: Front 3 ' Rear s( 7/ Side 7i i Street Side al-/ Garage ‘ 7' t$-Landscape Requirement: -e-Lot Coverage Maximum: `R,L-i3uilding Height: Maximum Height B6( Actual Height 3 r KVisual Clearance ❑ asements Sensitive Lands: 'Yes ❑ No Type .1V i2dyw,-fk 645,e,,i `S-urban Forestry Plan LI `-B-eonditions "Me "prior to issuance Q c fw ofbuilding permit /� Notes: gS.So 1 LI / /C �� (i G l -000 i% Building Permit Submittal Original Submittal Date: ea-/V//0 Site Plans: # Building Plans: # Building Permit#: 2 Enter building permit#above. Workflow Routing: Planning Engineering 1 ermit Coordinator ..'Building Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and _9.0.ginal plan review routing form. Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician J„ Date: — , /4„ ngineering Review Slope at building pad: ' Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat E Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in lieu: E Yes ❑ No LIDA Facility on lot: ❑ Yes E No ❑ NOT Approved by Engineering: Date: NNotes: Approved by Engtneering: 11 �2� Date: _ 7 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review E 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: ❑ Yes �' �T/A Tigard Trans SDC: ❑ Yes /A Parks SDC: ❑ Yes N/A • OK to Issue Permit Approved by Permit Coordinator: ///eVi--------Date: Z' 1-1---A 4O I:ABuilding\Fonns\BldgPennitRvw_RES_070915.docx City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NI Request for Permit ermit 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 ► City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) /1,r/1' Lim [/ ��6 Mailing Address: L/4/4) 5t assi City/State/Zip: dog_ 1_4 nJ i- O i2 97 a./ Phone No.: ij`b 3- a a 9" O 54/17/ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): • CANCEL/VOID PERMIT APPLICATION. red, REFUNhP RMIT FEES (attach copy of original receipt and provide explanation below). • , ' : - FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: H61-0-0/60-0.003 5� Site Address or Parcel#: /z7/0 59 ,544..) 1/9' g-- Project Name: 74-r2., u itAte),--/E-5 Subdivision Name: Lot#: EXPLANATION: (. , t_, )30-r- 474-0 6_ e 41912 6 7) rev 2 A-L.L._ !/rJ CnH Ati-4 S E l,/C.0 Lr,w U a L.:7-4-6 t= J-6 2 -0-1 a_t t..)Co . _ - __ - ; , - _ _ T€7�� Signature: vCitCer ,( _4 Date: 9/S/ f, -u A-(, Print Name: A-v'-t S k , �e i 7► yq Refund Policy i i7 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: aFI ' • Any fee which was erroneously paid or collected. CLr�✓ • 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 80%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. FOR OFFICE USE ONLY Route to Sys Admin: Date /k I Y' Route to Records: Date/a /'/6 Byk.— Refund Processed: Date 'O fro By -,ej®' Invoice Processed: Date By Permit Canceled: Date fr B Parcel Tag Added: Date By I:\Building\Forms\RegPernutAction_092 14.doc III`' p q TIGARD City of Tigard September 23, 2016 Atrium Homes LLC 4616 SW 42nd Place Portland, OR 97221 Re:Permit No. MST2016-00035 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: 14059 SW 119th Ave Project Name: Atrium Homes Job No.: N/A Refund: ® Check#222395 in the amount of$60.17. ❑ Credit card"return"receipt in the amount of$ . ❑ Trust account "deposit"receipt in the amount of$ . Notes: Electrical fees adjusted to remove low voltage charges, and refund the difference. If you have any questions please contact me at 503.718.2430. Sincerely, 0) ,/,47.67.1( Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefunAni3t33'tidhi erpTyirgiaegon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov Nm 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 Permit Action 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: Atrium Homes LLC DATE: 9/16/2016 4616 SW 42nd Place Portland, OR 97221 REQUESTED BY: Dianna Howse DA TRANSACTION INFORMATION: Receipt#: 403279 Case#: MST2016-00035 Date: 4/18/2016 Address/Parcel: 14059 SW 119th Ave Pay Method: Check Project Name: Atrium Homes EXPLANATION: Electrical fees adjusted and removed low voltage charges;refund the difference. a • E Fee 'es stton From RecF ;s. e W° No.0 I r t� Cash over 100-0000-48001 $60.17 TOTAL REFUND: $60.17 APPROVALS: SIGNAT RE DAT : 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 FOItT 1 E:r YS' 1?M AT?MINISTRA ION IJS,E()NIY k *. Case Refund Processed: Date: /0/j//4 By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14059 SW 119TH PL, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2016-00035 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14059 SW 119TH PL, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2016-00035 Inspection Type: Inspector: 699 Mechanical final Jeff Grove Result: PASS Comments: Provide dryer length placard Violation Summary: Inspector Contractor