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Permit (64) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT "'7r'' � Permit#: MST2016 00328 Date Issued: 09/07/2016 TFr,X11 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 Parcel: 2S112CB18600 Jurisdiction: Tigard Site address: 8026 SW BARNUM ST Project: Corbin Estates,Lot 3 Subdivision: CORBIN ESTATES Lot: 3 Project Description: New SF. 5/2/17: REPRINTED permit to include A/C unit. Contractor: WESTLAND INDUSTRIES Owner: JT ROTH CONSTRUCTION INC 12670 SW 68TH AVE STE#400 12600 SW 72ND AVE, STE 200 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-245-9715 PHONE: FAX: 503-598-9081 FEES Quantity Description Date Amount 1 ea Building Permit-New 09/07/2016 $1,844.36 Specifics: Construction 1 Plan Review 09/07/2016 $751.34 Type of Use: SF 1 ea 12%State Surcharge- 09/07/2016 $221.32 Building Class of Work: NEW 1 ea DC Provision Review,SF- 09/07/2016 $90.00 Type of Const: VB Ping Occupancy Grp: R-3 13 ea Info Process/Archiving-Lg 09/07/2016 $26.00 Stories: 2 $2.00(over 11x17) 57 ea Info Process/Archiving-Sm 09/07/2016 $28.50 $0.50(up to 11x17) 1 ea Metro Const.Excise Tax 09/07/2016 $384.85 1 ea Tig-Tual School CET- 09/07/2016 $2,979.60 Residential 3139 sf Permit Fee-Elect(per 09/07/2016 $338.14 dwelling unit) 1 ea Limited Energy 09/07/2016 $75.00 1 ea 12%State Surcharge- 09/07/2016 $49.58 Electrical 1 ea Furnaces< 100K BTU 09/07/2016 $46.75 Total $29,861.43 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You, • .btain a copy of the rules or direct questions to OUNC by calling 503.232. •• • .800.332.2344. I Issued By: rmittee Signature: � `- —r Call 503.639.4175 by 7:00 a.m.for the next available inspec •n date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE ESE ONLY City of Tigard �y � eived �l , I;;/B ? oar Permit No.: ; I �� 13125 SW Hall Blvd.,Tigard,OR 97223 litt [6��, ' a y' 7 rM1 ' I Phone: 503.718.2439 Fax: 503.598.1960 Date/By:Rev1eW Other Permit: T I GA R D Inspection Line: 503.639.4175 Date Read/B Internet: www.tigard-or.gov Ready/By: See Page for ��aa � 'Z01 Notified/Method: Supplemental Information TYPE OF WORK T1.60 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST y(New construction "ifr{>�' 1, r4 Mechanical permit fees*are based on the value of the work !�I 0 Addition/alteration/re G Ll y a 1S performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: U mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION otiI i' RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling 0 Commercial/industrial 0 Ace'.',1- ` For special information use checklist. ❑Multi-family 0 Master builder 0 Oth.4 Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 46 Job site address: 0 67/. k) /�A440, 4 4T- =�S 0 ( Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 17 Oita, /7 C] 2-7 7 3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name:[ // Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Slt" I ;/ ���1�/t/'�+�i t 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: l /3 iti f.cj-7;47-C 5' Lot no.:3Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 Gas fireplace/insert�„� DESCRIPTION OF WORK �. - " ",� ep 33.39 C ,G1 fir fire' Flue place for water heater or gas eP 23.32 Log lighter(gas) 23.32 „,...L.4Wood/pellet stove 33.39 "1-7;7016, ..,W30 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 POIRE� _ Other: 23.32 .. ' ,";; Environmental exhaust and ventilation: Name: 1 a ftk) A Nd i/19)11/4) Range hood/other kitchen Address: equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) �� •�: ,� � 7 � Attic/crawlspace fans 23.32 'dI CANT. ,. 0, CO TT P A . ' "® Other: 23.32 Business name: 1k1K611V') 1-�II J Till L�} Fuel piping: 'l y Il C $14.15 for first four;$4.03 for each additional Contact name: jtof+ t.IUJ) L) Furnace,etc. Address: i 70 41,0ogti AV(/ E, goo Gas heat pump Wall/suspended/unit heater City/State/ZIP: 1—( 6-1(112.43 (l 0 it, 1- � 0 ) Water heater Phone:(( ) 5-1a....071,tt, ►`� Fax::( ) Fireplace E-mail: 1�`q C( 06/1/1 d L L�O1 Range "► "` Barbecueg Wit CONTRACTOR, k max. ,, Clothes dryer(gas) Business name: 1'l(t Other: Address: SOLI it J 0 I,06_ v =zi„ * .i.L ERMIT FEES*..,: ki' y�/� t/ Subtotal, City/State/ZIP: l t L,...,,,a,./1- Minimum permit fee($90.00) - Plan review(25%of permit fee Phone:(,D3) I Fax:( ) P fee) State+� State surcharge(12%of permit fee) S''^, Li CCB lic.: ?V 3 ,-meq( TOTAL PERMIT FEE )_-7 / This permit application expires if a permit is not obtainecrwithin 180 gn /� * days after it has been accepted as complete. Authorized signature /��,,/, Fee methodology set by Tri-County Building Industry Service Board Print name: # �� Date: X , I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Q' --7d. Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fees $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 CITY OF TIGARD MASTER PERMIT !NI COMMUNITY DEVELOPMENT Permit#: MST2016-00328 13125 SW Hall Blvd.,Ti Date Issued: 09/07/2016 T6 ,�.R and OR 97223 503.718.2439 9 Parcel: 2S112CB18600 Jurisdiction: Tigard Site address: 8026 SW BARNUM ST Subdivision: CORBIN ESTATES Lot: 3 Project: Corbin Estates, Lot 3 Project Description: New SF BUILDING Floor Areas Reauired Setbacks Required Stories: 2 Bedrooms: 3 First: 1852 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 631 sf Garage: 656 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2483 sf Value: $320,705.23 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2483 Owner: Contractor: JT ROTH CONSTRUCTION INC WESTLAND INDUSTRIES Required Items and Reports(Conditions) 12600 SW 72ND AVE,STE 200 12670 SW 68TH AVE STE#400 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-245-9715 FAX: 503-598-9081 Total Fees: $29,809.07 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 wor. ' spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio• --.t- � 'se ru-s are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obtai -copy of the r•es or direct questions to OUNC by calling a '00.332 344. Issued By: �� �.�: .r�'� Permi e• ignature: ��•!�L� _��_ 3.639.4175 by 7:00 a.m.for the next available inspection d.r 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. 1 Building Permit Application Residential RECEIVED � roll orrlcl. I SI o\l.l �4 City of Tigard Received ` // Date/By: /b , A PermitNo.: Hy/�!/__.00 3�.cj 13125 SW Ha11 Blvd.,Tigard,OR 97223 Nan ReviewQ' � �"r �f u III ■ Phone: 503.718.2439 Fax: 503.598.196 UG 1 6 2016 O" -/6 ►/ Other Permit:§io1-2_ol4t-�2,K. Date/By: 1 i G n R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Pagental e 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Cr. , j I Supplem f/ BUILDING nivisicl�l 1 , i. 6-, ��l TYPE OF WORK REQUIRED DATA.,I-..AND.2,-FAMILY.DWELLING construction •ISI New 0 Demolition Permit fees*are based on the value of the work performed. ❑\�1 Indicate the value(rounded to the nearest dollar)of all ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTIONwork indicated on this application. and 2-family dwelling ❑Commercial/industrial Valuation: $ ;:),.0 7.`5 -t7 El Accessory building Number of bedrooms: 1 J/ ❑Multi-family El builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: �. i 3 9 Job site address: e3 , �' c-3,641„, New dwelling area: 4,03 square feet City/State/ZIP: l / OIL ,,�-1�,- Garage/carport area: 666 square feet Suite/bldg./apt.no.: V Project name: 7 62 .66i� porch.i�'IQ Covered area: aa" square feet Cross street/directions to job site: g I S � ck ar j T � ��/ �K--Iv�m square feet Other structure area: square feet ��� ��p REQUIRED DATA:COMMERCIAL-USE CHECKLIST C,.'1� Subdivision: - yJ . � = Lot no.: 3 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. G '_ Valuation: $ � Existing building area: square feet New building area: square feet PROPERTY OWNER 0 TENANT Number of stories: Name: ‘.e7'1-1 f �-�` – Type of construction: Address: '" I ���l L. d u-) N� Occupancy groups: City/State/ZIP: i .{,p Chi`-- ��)'� ,I Existing: Phone:( SD – (3 \ 4D 21 Fax:(� - (o Z'h— d 2-39 New: prAPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: W t��r� ./�1 ;) -` (e, (Please refer m fee schedule Contact name: `t i yi ��1e-;--11-11•. -W1 ���"� F � 1"S CJ J( 0� Structural plan review fee(or deposit): Address: ( ')�7 U (��) _ 9) *I FLS plan review fee(if applicable): City/State/ZIP: m 6_,—.121,k) 64_. q72_,-3 Total fees due upon application: ( Fax:: i3 Amount received: �y� e' Phone: ��•-�� " y(�i (�� ��7? ' ItcZ�\ 7�(..f E-mail: ,•'::c1 �C /1---a �.6 \ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive in on of roof-top mounted Photo Voltaic So •anel System. Business name: C j1/4 3t L 'r nW ll t 5 _.-Il\/ * Submit two(2)sets of roof t : with connection details Address: and fire department ac : along with the 2010 Oregon �–�U-�' 7O (p9'> ,cEe3 C _ f itstal>rjn .ecialty Code checklist. City/State/ZIP: ( !( �) � q-72....2._-, Permit e t es plan review c cand admire tive fees): , hone:(el--2j,; -7 ,0' . 0c. I Fax:( �u-��, 5 T -709 Stat surcharge(12%of permi 'lic.: di7 Total fee due upon application: --,„,,, i ed signal This permit applicatt no expires if a permit within 180 days after it has been accept, � ' Date: �`10 AG, *Fee methodology set by Tri-County Build' 1.146, Service Board. tri .,emits\B P-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling rolz (Ai lc i. t si oNt.) Received Permit No.: II City of Tigard Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: _ Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical ❑ Plumbing 0 Mechanical 24-Hour Inspection Line: 503.639.4175 I I G A R D Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW v`s No V/.' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. F U U 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. Vrar 0 0 3 Verification of approved plat/lot. ❑❑ 0 4 Fire district approval required. Name of district: 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 00 6 Sewer permit. 0 0 7 Water district approval. I ❑ 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. ae 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- v 0 0 basin protection,etc. //� ❑ ❑ 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ( 0 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. B 0 0 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. ❑ 0 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, iZr 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- 0 0 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. 0 0 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. hi 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. 0 0 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. _/ 0 0 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 0 0 systems,see item 22,"Engineer's calculations." 0 0 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. 0 0 20 Manufactured floor/roof truss design details. Et 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 2" 0 0 for four or more appliances. i/ 0 0 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or E ty 1 architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review. 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". Q' ❑❑ 0 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. L!7 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑❑ 00 E 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 0 0 0/ Street Tree List. 0 0 up 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, up and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. ding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit ApplicatioA: ECEIl� ; - FOR OFFICE USE ONLY Cl ofTigard Received ,�!to DU 3a g AUG1 6 �� Date/B : Permit#: S^ a 13125 SW Hall Blvd.,Tigard,OR 97223 20 Plan Review Phone: 503.718.2439 Fax: 503.59 ) Related Permit#: F t Date/B Inspection Line: 503.639.4175 v!'T1 TIGARD Ready Date/By: Anis: 10 See Page 2 for TIGARD l +f g Internet: www.tigard-or.gov $L11C®tdy ®iVisiQ� Notified/Method: Supplemental Information TYPE OF WORK 7 PLAN REVIEW 1iNew construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 0 Commercial-use a cultural 1-and 2-family dwelling 0 Commercial/lder ustrial 0 Accessory buildinggri amps for all other installations. buildings. Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived n - ❑100Addition moew motor load of system. Job#: Job site address: �L11/�J 1ooHP or more. ❑"A","E","1-2","t-3", ❑Six or more residentialunits. occupancy.!C ? DR„- y7-+a> 0 Health-care facilities. 0 Recreationa l vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: St $T 11 -hAn'\ FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: C-60(3,N 'e l's9'rL�>. Lot#: 3 Includes attached garage. �' 1,000 sq.ft.or less168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion /' 33.92 1 DESCRIPTION OF WORK Limited energy,residential j 0 e' cr-ie.."" (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) ?I-PROPERTY OWNERRenewable Energy 0 See Page 2 ! 0 TENANT Services or feeders installation,alteration,and/or relocation Name: ,...1-1-'41-4.1... r�f/-4 200 amps or less 100.70 2 Address: t')1�00 �k-�-2_ 44. �„�w-,t 201 amps to 400 amps 133.56 2 f�"`� G�+�+ 401 amps to 600 amps 200.34 2 City/State/ZIP: 1 I etheD o 2, ??yam, 601 amps to 1,000 amps 301.04 2 Phone: (0 C�.Zip�1V Fax:( 40"5 2 4 ,0„)....3? Over 1,000 amps or volts 552.26 2 4P 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 APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: j Cj5r Tptp .carat n V above service or feeder fee, 7.42 2 W �+W�a �l Wl ��� each branch circuit Contact name: „lit at SIIM DB.Fee for branch circuits without \l►��u�/�►�1 service or feeder fee,first Address: t 2.-(0?0 S /0 S 114 « V Iia branch circuit 56.18 2 City/State/ZIP: �/JJ 02 a?ZZ3 � Each add'1 branch circuit 7.42 2 IIMiscellaneous(service or feeder not included) Phone:(�j� !ao .ao Fax: :(9)2) 913-Qo 81 Each manufactured or modular Email: �//'"C � G ,'�/r�yr�„^ Reconnect t only67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: g��D up e �.�-�/1.G Sign or outline lighting 67.84 2 Address: .p.O . ---e,407( 131 .-- t�'�C1�-��f�i Signalnel, circuit(s)eron or extension. panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: , �ta� Each additional inspection over allowable in any of the above i L(.f1V 1 Additional inspection(1 hr min) 66.25/hr Phone:( ) ^ _ Fax:(5-63 _ Q?j'9 Investigation(1 hr min) 90.00/hr Email: �1 f(��y t3) 0-Ic/1� . ,/y� !� (, 7 Industrialspecos plant(1 whichhr no 9078. 0/hr ��, """���� W"Y v�/ \ Inspections for no fee is 90.00/hr CCB Lic.: Electrical Lic.: Z� rv.Lic (0 h specifically listed(/3 hr min) yJ v ELECTRICAL PERMIT FEES Suprv.Electricianiit�l�e,requir d�� J ` 1 Subtotal: Print name: Akf1r� f �� "�/ _ eigi,i. Date: 9 1 1t,, 0 Plan Review Required(25%of permit fee): NQ`�� •,, State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: G: This permit application expires if a permit is not obtained within 180 Print name: Date: i (� days after it has been accepted as complete. L- * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitAppEL RE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB I 1 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 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: Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 IX/Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed('A hr min) ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 A , Mechanical Permit Application FOR OFF ICF USl.OyL1 City of Tigard Received ,..,„ =MM. Permit No.: r�,o,_ $' :1111 111 4 13125 SW Hall Blvd.,Tigard,0I C I VE Plan Review O Phone: 503.718.2439 Fax: 503. Other Permit: Date/By: T i G A K D Inspection Line: 503.639.4175 Date Ready/By: Jur Internet: www.tigard-or.gov AUG 16 2016 Notified/Method: Supplemental Page 2 for upplemental Information . ': TYPE.:dii v j F -1 IUARD COMMERCIAL FEE* SCHEDULE -USE CHECKLIST ArNew construction 0 Additilljl}erdtj ngp YrilS tO N Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF- CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* J 1-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 n Heating/cooling: JOB SITE INFO TION AND LOCATION Air conditioning .75 Job site address: 45 O2� �,A/� Furnace 100 000 BTU(ducts/vents)\ ( ts) ( ✓ 46.75 City/State/ZIP: , I��-Iq 1 6(2- Q .2.3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: , Project name: l Heat pump 61.06 Duct work 1 23.32 Cross street/directions to job site: t�1 fwHydronic 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: 5Lot no.: aj Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater ( ./ 23.32 DESCRIPTION OF WORK r. Gas fireplace/insert 33.39 mow_ �_�,; r "" "`' Flue vent for water heater or gas NI e " �� - . fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 PFR'IY O ©tTT E Environmental exhaust and ventilation: Name: �� -T-6. ,.V� Range hood/other kitchen eqAddress: (240150 l lTj �t . -72- 11) 'J4'244 -4 Clothes dr • 33.39 / " JV �•v Clothes dryer exhaust t�33.39 City/State/ZIP: ''c oQ Q?3.2.-3 Single-duct exhaust(bathrooms, lJ�+ -( toilet compartments,utility rooms) 23.32 Phone:(c--b3._ & .3 j_ Fax:( :J t ` �'� �G9rJ (924_ 62..39 Attic/crawlspace fans 23.32 11-APPLICANT A .. �;❑�~SOT ACT PERSON Other: 23.32 Business name: Wer--Az,Q,� ,^AE 3? Fuel piping: ��+ 3 s $14.15 for first four;$4.03 for each additional Contact name: :` ,�/1 s-r•,/1 a -De. oh-- Furnace,etc. Address: r r l .r J`�lv'~(0 a Gas heat pump `��� �-Q �" - Wall/suspended/unit heater City/State/ZIP: n,c, Or-. q72.-2,-77 _ Water heater t Phone:( 9)3 . '7 ) .. 06),,,, Fax: (�� ($ ti1 Fireplace I E-mail: Q� eRange S {.+ ✓ -L t V 0 �_`( Barbecue CONTRACTOR Clothes dryer(gas) Business name: IC.z: dUy hfi Other: A G 1 t��+ G�t , MECHANICAL PERMIT FEES* Address: V64 Rea) 6- 6 Subtotal City/State/ZIP: V Minimum permit fee($90.00) Phone:( s}� ., q$/a -D 434 f) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: 2.0 3 S"q 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: 14 * Fee methodology set by Tri-County Building Industry Service Board Print name: ec ( te: 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 Plumbing Permit Applica * Building Fixtures CEIVED FOR OFFICE USE ONLY City of Tigard AUG 1 6 2016 Receiv III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Permit No.: IN' a„Ole_�?�� l: Phone: 503.718.2439 Fax: 5°0191311'96F 0 ' 966 DPlan By Review TIGARD Date/By: Other Permit No.: T I GARD Inspection Line: 503.639.417WILDING L�JJ Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov NG DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE For special information use checklist } few construction 0 Demolition Description I Qty. I Ea. I Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft fnr each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath I 312.70 -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: lil O y .S WtQxtvtok Catch basin or area drain 18.76 City/State/ZIP: `( C.� 4 � Drywell,leach line,or trench drain 18.76 ,1 ` Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 01 ST t .3( 0vlvh. Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) I Page 2 Storm sewer(no.linear ft.:_) L Page 2 �'�,4 '✓l• ) G t. Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.:�j Fixtureaor or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 Dishwasher ( 25.02 Drinking fountain 25.02 1 Ejectors/sump 25.02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Tr t c x' ` :y/ _ Fixture/sewer cap 25.02 Address: %94066' `T`5.. \^�`` 72 20O Floor gedrosink/hub 25.02 tN 1 Garbage disposal25.02 City/State/ZIPt� a-, 0R- q722 3 Hose bib I `"` 7/ 25.02 Phone:�s (0 ' Z(P2,q Fax:( €0..)T-b Ice maker ' 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: W IJ� V1,,` ,,.., /�_E5 c_ Medical gas(value:$ ) Page 2 e "ital ;�Jj7I1�'� Primer 12.51 Contact nam eat �� Roof drain(commercial) 12.51 Address: 7.4.70 5t)..s, to Os 011106 Sink/basin/lavatory 25.02 City/State/ZIP: 1eti:tel / Z 23 Solar units(potable water) 62.54 Phone:(552p " Sts Oxo 7,40 Fax::(9/,!,t$ et g\ Tub/shower/shower pan Ili 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater ( 37.52 Business name: 2 P I,. 1�orn G W►Mawr; I L Water piping/DWV 56.29 Address: ! /2*6I5 gri Other: 25.02 City/State/ZIP: J ag-' 4'7 T,)t I Subtotal Phone:( ) Fax:( ) �ftMinimum permit fee: $72.50 CCB Lic.: Cho'a Plumbing Lic.no.: &tf,.- s rw, Authorized signature: Plan review (25%of permit fee) ji.... eryits2. a State surcharge(12%of permit fee) TOTAL PERMIT FEE Print name: pj� 6 u ( � I Date: I This permit application expires if a permit is not obtained within 180 days TT"`'� 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(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-l'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 Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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 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 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 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 ❑ 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" 3" Isometric or Riser Diagram 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 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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT . •s T 1 G n R D Building Permit Review — Residential Building Permit #: H/ --C",,p-o1 (p -v03 g Site Address: S 0,R(0 S c,J 13o ,,,u,,.,,-, Project Name: C.-0,=1a', ,, E -1--c k S Lot #: 3 (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N e �� t 2- Verify site address/suite# exists and active in permit system. XRiver Terrace Neighborhood: r No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: R"fhree(3)copies of site plan Xisting structures on site aj-Site plan must be on 8-1/2"x 11"or 11 x 17"paper kFootprint of new structure (including decks)with finished ii-Drawn to scale(standard architect or engineer scale) floor elevations ,North arrow KrUtility locations (required for new,may apply for additions) l-Site address,project or subdivision name and lot number ,TLocation of wells/septic systems ,"Applicant information(name and phone number) _rosion control(including drainage-way protection,silt fence 111.ot dimensions and building setback dimensions design,location of catch basin,etc.) Jot area,building coverage area,percentage of coverage and I5treet names impervious area (applicable if R-7,R-12,R-25&R-40) ❑Street tree size,type and location PDroperty corner elevations(2 foot contour lines if more than .lExisting trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services-Service Provider Letter $• slatted prior to 9/10/1995): Required: Yes,applicant was notified e ' o Received: E Yes ❑ No Ar Public Facilities Improvement (PFI) Permit: Required: g Yes,applicant was notified ❑ No Applied For: Pri Yes ❑ No,stop intake 2'Land Use Case#: 5 i.L♦.) c:40. 1 — 0000 V.VA��Zoning: R _ 4 ,5 Ro2 U j 4-71 — 000_,Z,), Yi Setbacks: Front )0 Rear j 5 Side 5 Street Side I-5 Garage .?o f2-Landscape Requirement: -- cyo ,YJ Lot Coverage Maximum: 'Building Height: Maximum Height 3 0 Actual Height , 5 ZVisual Clearance Easements 4 Sensitive Lands: ❑ Yes 0 No Type t(Urban Forestry Plan 137 Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: ed %A,1 , a . Date: $ -I t. - (So Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPennitRvw RES 012116.docx Building Permit Submittal /i / /, Original Submittal Date: b ( 4v Site Plans: # '3 Building Plans: # 3 Building Permit#: Er-Enter building permit# above. Workflow Routing: ❑-Planning a-Engineering LY-Permit Coordinator Er-Building Workflow Sign-off: E Sign-off for Planning(include notes from planning review) Route Application Documents: a-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original 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: 0,414/K--4-1-43 Date: g//4e/(0 Engineering Review Slope at building pad: ‘149 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 I No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: —P Date: = ffa:-4 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: E 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: DC Fees Entered: Wash Co Trans Dev Taxes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: 719 Yes ❑ N/A K to Issue Permit Vf2v2//Approved by Permit Coordinator: Date: 1:\Building\Forms\B1dgPennitRvw_RES_012116.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8026 SW BARNUM ST, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2016-00328 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: 8026 SW BARNUM ST, TIGARD, OR, 97224 May 12, 2017 at 8:16:12 AM Record Type: Record ID: Residential - Master Permit MST2016-00328 Inspection Type: Inspector: 399 Plumbing 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: 8026 SW BARNUM ST, TIGARD, OR, 97224 May 12, 2017 at 8:29:36 AM Record Type: Record ID: Residential - Master Permit MST2016-00328 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Final erosion control approved. Street tree certification received. Moisture content form received. High efficiency lighting form received. Insulation certification checked. Duct seal test report received. Contractor on site to seal Lid in mechanical room, to be mud and taped for required separation. C of 0 left on site with contractor. Violation Summary: Inspector Contractor