The URL can be used to link to this page

Permit (10) Y MASTER PERMIT Ili CITY OF TIGARD ' COMMUNITY DEVELOPMENT Permit#: MST2016-00352 IMAM 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2016 I` R D9 Parcel: 2S104CD03200 Jurisdiction: Tigard Site address: 13530 SW HILLSHIRE DR Subdivision: HILLSHIRE ESTATES Lot: 32 Project: Simon Project Description: Convert 755 sq ft of crawl space to master bedroom and bath. 11/30/16 REPRINTED to add furnace, a/c,gas fireplace and add'I gas outlets for gas fireplace, barbecue&furnace. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 0 of Basement: 755 sf Left: 5 Parking Spaces: 0 Height: Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 755 sf Value: $55,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 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: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: Ea add'I 500 of: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 5 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 N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 755 Owner: Contractor: SIMON,JEFFREY D PACIFIC NW VENTURES LLC Required Items and Reports(Conditions) 13530 SW HILLSHIRE DR 19180 INDIAN CIRCLE AVE TIGARD,OR 97223 LAKE OSWEGO,OR 97035 PHONE: 503-380-1470 PHONE: 503-828-7836 FAX: Total Fees: $3,311.16 This permiLis_issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be one in accordan with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 ays. ATTENTION: Oreg law uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 9 1-00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: K , Permittee Signature: /� �) .417 by7:00 a.m.for the next available inspection date. �_ Ca11503.539 5 p This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE I_SE ONE City of Tigard Received PermitNo.:H.06,/{5/6,....0035—,2.-- 1111qDate/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960Other Permit: Date/By: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction EI-Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: n .-Air,conditioning 46.75 3 �� W Hi ii� tv �+ a-Furnace 100,000 BTU(ducts/vents) ...Z.- 46.75 Z City/State/ZIP: CI Cj,� l 0 Furnace 100,000+BTU(ducts/vents) 54.91 lJ l 9 2:2-2:2- Heat pump 61.06 Suite/bldg./apt.no.: Project name: v-Duct work 'Jj 23.32 T Cross street/directions to job site: \ in U r\\ 1,J� 1 � �� \ Hydronic hot water system 23.32 'S 1 C1� C% Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: — Other fuel appliances: Tax map/parcel no.: ✓Water heater 1 . 23.32 DE ON WORK {*°5fireplace/insert 33.39 1 c'•Q "r) - - Flue vent for water heater or gas _Y\� )\- -�V 'V-•C -7_/ n 6.,,_.) 3U (.tj fireplace 23.32 C a /( "�-[.J �5 \ t r\�� /3riCLog lighter(gas) 23.32 �"t (� % � Wood/pellet stove 33.39 t -X k c 5- i ` SAY(V(c c '� CDS �� C,I L,I rl t��y Wood fireplace/insert 23.32 ex hGk V S�(x)j p ?D !_ Chimney/liner/flue/vent 23.32 Li PROPERTY OWNER C� , 1:„ ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen Address: equipment 33.39 v"--Clothes dryer exhaust '1 33.39 '7 City/State/ZIP: ✓Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT ' 0 CQNTAC F PE ON, " Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: yyy*,,,,,, Furnace,etc. . Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: e,i Water heater X t Phone:( ) Fax::( ) Fireplace .2 Range E-mail: CIA Barbecue .,Z 1 Clothes dryer(gas) • CbN'T'�tACTOl2 /� -VA . Other: Business name: t l -` �i n� �l 1�� MECHANICAL PERMIT FEES* Address: q " *.c,(?)\_ 7 t A.v f Subtotal City/State/ZIP: ci i— ( �(/ `-, R. q 7-(„ 2... o Minimum permit fee($90.00) Phone:(5-63v\ - Fax:( ) Plan review(25%of permit fee) �� State surcharge(12%of permit fee) CCB lic.: l (a 9 .z //////7 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 /-r ter_. days after it has been accepted as complete. Authorized signature: , * Fee methodology set by Tri-County Building Industry Service Board Print name: -c-._c,A-- c� c`ZZJ Date: ///2C1/J 6 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Nov. 18.2016 05:06 PM United Plumbing 5034918671 PAGE. 1/ 1 Plumbin. Pe mit Ali li _1 ,'f (,, Building Fixt res - -El"Fri tr flit, (t i Ih 1( l t SI ()NIA City o i Tl andReceived /" IN _ Permit No.:H4 /&'-c 352- }t ■ 13125 S • ail Blvd.,Tigard,OA (9722321 2016 Date/By: Plan Review . Ili Phone: 5 3.718,2439 Fa 9 : 960- n1dOr: Outer Pemiit No.: •1 t�. n it I lnspectioi Line: 503.63 r 5 t 116:A O Date Rvvdy/Dy: Juri,: I &I Sec Pwge 2 far T Internet: ww,tigard-o> LU1t jG i nirisie t Notified/Method: Supplcmenl*!information TYPE OF WORK `" 0 New construction 11 Demolition FEE* SCHEDULE For special lniormnllon use checklist ddition/oltcration/n..laccmcnt © Description Other: ('pry. f (?n. Total CATEGORY OF CONSTRUCTION New I-2-furnity dwellings(includes 100 R.for each utilittconnection) - SIR(I)balk 312.70 W-t-and 2-family dwell ng ❑Commercial/industrial - 1 SFR(2)bath 437.78 LI Accessory building 0 Multi-family SFR(3)bath 50032 ❑Master builder ❑Other: Each additional bath/kitchen 25.02 JOB SITE INFORMATION AND LOCATION .Fire sprinkler( sq.(1.) Page 2 Job site address: 2 " Site tilities: _ J a SC+ �� l ds LAI,'" P I` Catch basin or arca drain18.76 City/State/ZIP: 1 r /Q ry -�Q T.�� D ell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: Project name; Footing dndin(no,linear R.: ) Page 2 Cross street/directions rajah site: e ct.5 14-d Manulbetuf cd home utilities 50.03 11 / -Manholes 18.76 (J VI t re C'I i/I C.1. I�!'t i r1 C '� �X'/.5 -T1^✓t cj P L41 ,�- fi ms't t I(n --C7 0 3$ Z I Sanitnary drain sewercon(n .lr Page 2 Sanitary (no.linear 11.:�� 2 . Storm sewer(no.linear ft.:_) Page 2 Subdivision: Lot no.: Water service(no.linear it: ,._) Page 2 Tax map/parcel no.: Fixture or item: DESCRIPTION OF WORK Backflow prevcnter ._31.27 j) {� p Backwater valve 12.51 3 11-T-L.v 0 r ,` u f--v' 5r"4.k /�-,.rts'f &J .S/n L1t Clothes washer 25.02^ )1,1_-C, C_1.--Ltl‘to 13 n x1,,,1 G 5 e-W1 - '-'- 'Dishwasher 25.02 Drinking fountain 25,02 0 PROPER' OWNER 0 TENANT Ejectors/sump _ 25.02 ... Name: Expansion tank 12_S l Fixture/sewer cup 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Gatbuge disposal 25.02 Phone:( ) lax:( ) Ilose bib 25.02 - 0 APP 1 CANT 0 CONTACT PERSON Ice maker_.. . _ , 12.51 Interceptor/grcasc imp 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: - Primer 12.51 Address: Roof drain(commercial) _ 12.51 City/State/ZIP: Sink/basin/lavatory 25.02 Phone:( ) Pox::( ) Solar units(potable water) 62.54 13-mail: . . 1 , /t Tub/shower/shower pun 12.51 13-mail: 1 .Al a h I[I I r rt 1.(I r 6 c Cr? r-t-t Urinal 25,02 CONTRACTOR Water closet 25,02 Business name: Un 7- f)1 tJ r 1()r°.1(1 Water heater 3732 Address: PC� /3 ?- q.-7 1 Waterpiping/t)WV 56.29 City/Stole/ZIP: c. ct,l.,,(-- i It.e„-J/ CZ y' 70..2-- `( Otter: 5ubt Ml Phone:(Th3)7r2- sLi�(D Fax:(rip ) /'{9/-8°6 / / ..... Minimum permit fee: $7230 CC13 Lie.: ICD //Sr1` Plumbing Lie.no.: P s-41Plan review (25%of permit fee) Authorized signature: C State surcharge(12%of permit fee) Prins Hunte: Date: - TOTAL PERMIT FIX ZIA 3-Q v1 Ca wt to -dr 9 11-1 W' // -- 1:1nultdins\rooaluaryaU-rani App.oc 10/01/09 440-6616T(10/09/COM/Wn11) A 11/22/2016 3 : 33 PM FROM: HOMESTREET TO: +15035981960 P. 2 i Gv J I at Ol --{-J( t.,st 51-'0,1 C✓ f ems(t e_ca t r-.=', rr. t'T Electrical Permit Application) REG , ,� r ° City of Tigard emu]nittetBy Permit 8. H.. -E---,,,,.e,/to-(�3Sd - 'r 13125,SW Hall t3lvd.,Tigar 5(?3.598)23 __.� _-._.__ _ _. 8 - Han Reviewt 2Phone: 503.718.2439 .1960 NOVN 0 i�" 2 ? 2016 t>ttch3y. Related Permit II: Inspection Line: 503.639.417. Ready Date/By; torts ( ® See Page 2 for T 1 COA RI) Internet www.tigard-or.gov r lificd/MethodCITY F 1 tc Supptemeatal Intormabion _a TYPI OF-?WO 11 }..•, trt'1"..' ;f,. , t . .;' PLAN REVIEW .t ❑New construction Addition,alteration/replacement I ?lease cheek nillthat apply(sot mit 2 nets of plans whtes;s checked) [ ❑Service or feeder 400 amps or more 0 Building steer three stores, i ❑Demolition Other: where the available fault Curren) 0 Marinas and boatyards. 1./::4' CATE000.::OF OtON.STRLiCTIION exceeds 10,000 amps at 150 volts or 0 Floating buildings. p 1-and 2-family dwelling C Commercial/industrial 0 Accessory building less tt ground,or exeteds 14,000 0 Comrnercial-ttse agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder ❑Other: ❑rare pump. 0 Installation of t50 KVA or JOB SITE INFORMA'T1O1"1 4N1),LO(rATIO1V 0 Emergency system. larger vsp irstcly derived C .r- 37 5 JL ,f, 4+ , pr, Addition of new motor loattof system, Joh#. Job site address: %4f (j ll^C IOOHP of more. ❑"� [ t-z»"1-3" /� ❑Six or more residential units, occupancy. City/Shite/ZIP: f..-d O,1C_ . ❑Health-care facilities. 0 Recreational vehicle parks. Suite bidg.fapk#: �i I Project (/name:: CIHaOSudons hxaions. 0 Supply voltage tar more limn - 0 Service or feeder 600 amps ar more. 600 volts nominal. Cross street/directions to•jobSite: FEE SCHEDlrLl �'1 _ ; nesrnpfien .._._ i. Facs I Total _.l. ^ �_ _ I New residential single-or multi-fancily dwelling unit. • Subdivision: I.,ot 4: I_Includes attached garage. Tax mar parcel : � 1000 sq ft.or lets 168.54 4 i p p Fa.add'I S00 sq It or portion 33.92 1 : FF:' DLSCRIPTION 9OF WORK ` ' -,_ .. , ' ;. I Limited energy,residential r -- , (with above sq.ft.) 75.00 , .. : Limited energy,multi-fantity t residential(with above sq.ft.) 1 7500 2 �-y 1 Renewable Energy i❑ See Page 2 1 L_ pRopori oWINER 0, NANT"r'' -- Services or feeders installation,alteratton,and/or relocation 1 Name: 200 amps or less 100 70 •_ _ - ___— __ _--____. ; 2111 amps to 400 amps 133,56 2 Address: _._ _ _ .---._ ..-_ - 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over I,O3u amps or volts 552.26 Temporary services or feeders installation,alteration,and/or Email: { relocation Owner installation;'l'his instslla ion 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. 1201 amps 1©400 amps 125.08 2 Owner signature'. _ Date: 401 amps w 599 amps i 168,54 1 2 + S Branch circuits--new,alteration,or extension,per-panel �:Ai'rLii AN .' -(O�rrAcr .T.A 3t)1d , A-.Fuc for branch circuits tu;rh Rosiness name: above-service or feeder fec, j n 42 2' ..____- — each branch circuit 1 Contact name: 1 H.Fee for branch circuits without ___.___. _ - _ ____._ W__ _ - I Address: service or feeder fee,first branch circuit 56 18 2 City/State/ZIP: Each add'tbranch circuit 7.42 2 — •-- ---- . Miaeellancous(service or feeder not included) Phone:( ) Fax :( ) Each manufactured or modular Entail: - dwelhng,service and/or feeder 6'.84 4oNi'RA±Cf(3R . . . 67 84 2 Reconnect only -i: Pump or irrigation circle e'.84 Business name:Hi fie. riecirtcc_.._ 1 Sign or outline lidding 67.84 2 ' t See Signal clrcui!(s)or limited-energy ' SPae 2 Address t 1(f � C. Happel,alteration..or extension.___L_________-_ �_ City/Stale/ZIP: Cly� ? Each additional inspection over allowable in any of the above • 7 ) Uel/ )'i 3� (1 ) /2 f 4, investigaboa(I hr i )hr min) I 90.00 nt _. �_.-____. Additional inspection66 i Phone: � Fax: C'r✓3 � -� "� � � r min) 9(t GD/hr i Email: 14/ (�L( e c��j�J ey ea. !.-04.,67 11 p))l t Inspectio}slant(i hr min) 78 18?hr -_-.__�_ Inspections for which no fees tgl4\1 1CCHLie.: /766' ;-.1.-y 1 Electrical Lie,: C?0 uprv.Lic.: �d'/5- l, listedh5 hrmin 90,00,-hr I a.I WT.RiCAI. PI RMiT FEES Suprv.Electrician signature,required: �+G .--1-1_5_ _ Subtotal: i Print name: e f4freviLt' keg soy Tate: /�' 2 Z-"/7 0 Plan Review Required(25%ofpermit fee) � State surcharge(12°6 of permit fee) Authorized signature: TOTAL PERMIT FEE r • m---...._- ._-____ _ __---._.-__._. This application expires its --------------- permitpp p permit is not obtained within ISO 1 Print name: Date: days after it has been accepted as complete. .-----_--- ... - .-. '~ Number of inspectis ms allowed per permit. t.'/Building\Prunus I_C Perrr'IApp.LI.R_ERE.doe Rev Osui7l20;5 445-461yr(t 1105/CGM/R'E'.3 11/22/2016 3 : 33 PM FROM: HOMESTREET TO: +15035981960 P. 1 Delivered by FaxCore Fax Transmission Attention to:- From:- 2, 9 2Q16 Name:HiDefElectric Name: Nc)i Company: Company:HomeStreet Bank I �a� i 1, r. ° N1 Date:2016-11-22 Telephone: ,.,k$ ,-., r �,i1c g ' Time:03:3c17:7 - 1:42 P Pages:21, 1 ? RE: Hi Def Electric comments/Notes: Thank you, ,,--'--- Denise Higgins f� Lake Grove Retail Banking 3970 SW Mercantile Dr.Suite 105 f Lake Oswego,OR 97035 ' , PH: 503-445-4550 3( Fax: 503-496-0441 r [cid:image002.png@01 D138DE.A69CB000] hsb encrypt U FOR OFFICE USE ONLY-SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT _ * Transmittal ansmlttal Letter 1 't,n Et n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: l4' DATE ;t f r.9 iflk d 404i) DEPT: BUILDING DIVISION NOV 2 9 2016 FROM: -- -cc"'CG \ okZ-Z© ail l t t 1 i .� R .. l �� ' ��+ W VC►l-tv \hc5 LLC. ' :sio 4' COMPANY: \ _c__.\. -� � � PHONE: (S`03 J 2` g 6 By: RE: 1 85-30 5w 1-(. as 1 c c,_ 6 F 09(hotio- rip 35(Site Address) erm' urttr) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: I Copies: I Description: Copies: Description: Additional set(s)of plans. 3 Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): 1 / REMARKS: ik-•� P t c.Y c-- c"--c__ <o c_,,, c i]c,SA e rs `dr'ye c-- FOR OFFICE USE ONLY Rou t� 'ermit Tec cian: Date: )) -011 . ) .£ Initials: F 0 ue: ►:1 Yes ■ No Fee Description: Amount te: O.6.- #Jr p).* rcv:c,' $ (.J - A-DD'L. N ta/-r $ !Mo.$`9 ,' t t,t L I`i £e.,4 54�ftCug,2doe $ I5 . RV, Ab N A ��ti . 5 m'r' Special a 3 a,`I Instructions: Re rint Permit(per PE : Yes ❑No ❑ D e plicant Notified: ( a e: /1 41.1)//(P &,/ At ---I Ini als: k I:\Building\Forms\TransmittalLetter-Revisions 061316.doc CITY OF TIGARD MASTER PERMIT ` COMMUNITY DEVELOPMENT Permit#: MST2016 00352 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2016 T[Cl� 9 Parcel: 2S104CD03200 Jurisdiction: Tigard Site address: 13530 SW HILLSHIRE DR Subdivision: HILLSHIRE ESTATES Lot: 32 Project: Simon Project Description: Convert 755 sq ft of crawl space to master bedroom and bath. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 0 sf Basement: 755 sf Left: 5 Parking Spaces: 0 Height: Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 755 sf Value: $55,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 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: Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 5 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 Ecom asin N Other: N Other Description: p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 755 Owner: Contractor: SIMON,JEFFREY D PACIFIC NW VENTURES LLC Required Items and Reports(Conditions) 13530 SW HILLSHIRE DR 19180 INDIAN CIRCLE AVE TIGARD,OR 97223 LAKE OSWEGO,OR 97035 PHONE: 503-380-1470 PHONE: 503-828-7836 FAX: Total Fees: $2,978.25 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes • - - •-r 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 . pende. for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent-r. Those rule j,- set forth in OAR 952-001-0010 through OAR 952-001-0090. sin a co r m� s or direct questions to OUNC by calling 503.232.198'o X1.800.332.2 ., . � Issued By: r �' Permittee Signature: /. C 9.4175 by 7:00 a.m.for the next available inspection date/` This permit card shall be kept in a conspicuous place on the job site until completion of the proje Approved plans are required on the job site at the time of each inspection. T r Building Permit Application Residential RECEIVED FOR()Fr1Ct: l sl:()NIA Cityof Tigard Received g 9 7 /6 ��ij Permit No.:kel./ �� O0?, 13125 SW Hall Blvd.,Tigard,OR 97411 Date/By: �p— e ( 2016 Plan Review Phone: 503.718.2439 Fax: 503.598. 43 Date/By: v 1�-,'1 Other Permit: T 1 G A R D Inspection Line: 503.639.4175 ``OF TIGARD Date Ready/By: v Juns: H See Page 2 for Internet: www.ti and-or. ov CI r Notified/Method:, 'F.' �� Supplemental Information g g BUILDING DIVISION /s`rerr- TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all .Addition/alteratic.i/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION Iwork indicated on this application. 4. and 2-family dwelling ❑Commercial/industrial i�Valuation: $ r~�J WO ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: "' -, Job site address: k. 5-.-30 sl'w i-i', 11,k-,,_---- ,,, 7' New dwelling area: square feet City/State/ZIP:�'i js"*�C1�v Ca �� v/ Garage/carport area: square feet Suite/bldg./apt.no.: J� Project name: 6 i,,,.^,u(-1 Covered porch area: square feet Cross street/directions to job site: I vAt,; C: (`v- Deck area: q square feet c) -k _5 \ re bt de ['� �� rry� �C 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. `.�vC� `� tk Valuation: $ !° J 5\e 6-- (">0-1. �,, - Existing building area: square feet New building area: square feet FLPROPERTY OWNER 0 TENANT Number of stories: Name: r_ick--',7-,,,,.N �i/N-7)04 6*- Type of construction: Address:j 3 c0 34 //,//3,tit ,� a Occupncy groups: City/State/ZIP: /�yExisting: J� Cr��` Phone:(5 o3) r �� % �S��.- /Z/7 0 Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (PleaBusiness name: �ti,t iSy JU �1l {rn Ars review fee efertofeeosit):le) l Structural plan fee(or deposit): Contact name: takL:-(2,,::„.// ,+ FLS plan review fee(if applicable): Address: jell l sO N�%11 el.i�l Crt>r 6. v to City/State/ZIP: �,, t: 1,1 e c 0 q n)3"' Total fees due upon application: !( ) Amount received: - 4nj eo,. Phone:15 ) qui 1 `1 q Fax:: E-mail Pel( . ,Gow i1 C11 f? t t l,4:4111-1 zJ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 1 Commercial and residential prescriptive installation of CONTRAC R roof-top mounted Photo Voltaic Solar Panel System. Business name: e.,," • �� l r� L�� Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:19 186 I n L f� v L Solar Installation Specialty Code checklist. City/State/ZIP: LA « Y/� Permit Fee(includes plan review ty (� : LA -5_� /!0:3 — and administrative fees): $180.00 Phone: 1„) ( ) CCB lic.: � ' 47/7 State surcharge(12%ofpermit fee): $21.60 00 /7___ 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: Date: *Fee methodology set by Tri-County Building Industry C Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) f v Building Permit Application Checklist One- and Two-Family Dwelling roil 0141(1: tsi ON 1.1 City of Tigard Date/BReceived Permit No.: III4 13125 SW Hall Blvd.,Ti ard,OR 97223 at g Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T I G!�R D Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les yo y/,' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • U 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 ❑ 3 Verification of approved plat/lot. ❑ 0 0 4 Fire district approval required. Name of district: • 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0 6 Sewer permit. 0 0 0 7 Water district approval. 0 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 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 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 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. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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- 0 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. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 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 0 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 0 0 0 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." . 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0 i 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 0 0 architect licensed in Ore•on and shall be shown to be a•.licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 0 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. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ ❑ 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, El 0 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. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Residential RECEIVED ► (.0, , l(l: l Sl: O\l.1 City of Tigard Received ci / f 7 6, �h Permit No.:i-Ar of Date/By: 6..._60 3 Ste. 1,1 r 13125 SW Hall Blvd.,Tigard,OR 974F p 7 2016 Plan Review ■ Phone: 503.718.2439 Fax: 503.598. Date/By: Other Permit: 1-l(,n R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information 417 4t� s ' iiiii 1� �J� � ` ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. ddthon/alteratton/r lacementOther: Indicate the value(rounded to the nearest dollar)of all eP 0equipment,materials,labor,overhead,and the profit for the hN f f S eii) F Oi 6 Ofti ,- r r work indicated on this application. t--; Valuation: �.1..and 2-family dwelling 0 Commercial/industrial ' $53-- 7)00 ❑Accessory building ElMulti-familyNumber of bedrooms: ❑Master builder 0 Other: Number of bathrooms: f #- .JOS�E O �1 �ATIO Total number of floors: -, 3 A. .i-1" s,.,. r ..,, -ate^.. t�sr v -,, .z >. s i�.�.' Job site address: �3�r.0,Cw F1'i 115 1,..--c-,)„.., New dwelling area: 1/` square feet � City/State/ZIP: 1� i ^ �Z� / ` � Garage/carport area: feet Suite/bldg./apt.no.: Project name: S'7 el,..-) ,n Covered porch area: square feet Cross street/directions to job site: Ida`nu-t—C r 5cI--'ckickey' rv— Deck area: 45— square feet ¶"0 i-k; `\ _ 1/:-.v re bT ;,-j r. e S ©a L.L`2i Other structure area: square feet 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 h" AC -- � e W,j atC �5 < F ' � X work indicated on this application.{ Icy � Valuation: $ (...onUCr-\-n )ct5 I n‘011 cLJ .,SCS to — fiiatsVer beXr�®(7 � �J o(V Existing building area: square feet ��r�i�111 New building area: square feet 7' O� ' x ThN ' » „, Number of stories: .r �, , ... ._ _.� �.�-, ate,, . = � .. Name: ---.i° ,r�`7` .i/1.7 fl Type of construction: Address:135 3 0 ,3(,) 1-11;fi k t r_ Occupancy groups: City/State/ZIP ; ��eL a. Da_ '7-6. 5 Existing: Phone:�03)3 New:X970 Fax:( ) `` < .,„ lPLICAfii'-r CON i'ACT PERSON . LL' BUIIE DING PERMIT EES` (/lease:releir tofeaschedule :Businessname: A,C,-c; 1it'\O eS1�� ": / Structural plan review fee(or deposit): Co::::ua; , e: 42+ A ex.-zzo Ad : 36 h 1 arl 6r-teld.- .Ave FLS plan review fee(if applicable): City/State/ZIP:!�a/ct �)l 2 ' ' Total fees due upon application: Phone:5 3 ) i 8 .- e1 j' Fax::( VV) Amount received: PHOTOVOLTAIC SOLAR PANEL SYS 'EM FEES* E-mail: Perk .Ln,y vin f�5 a� C��i t,cor'1 CQN;iR#CI`JR Commercial and residential prescriptive installation ofl� roof-top mounted Photo Voltaic Solar Panel System. Business name: Pixel t. �� till-Lift" Ll_� Submit two(2)sets of roof plan with connection details / and fire department access,along with the 2010 Oregon Address:1I18O 1�n6rA v . Solar Installation Specialty Code checklist. City/State/ZIP:+ �� DS�� 6 /1; 5' Permit Fee(includes plan review $180.00 (J and administrative fees): Phone:(543) g&13 /3 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Z06200 Total fee due upon application: $201.60 Authorized signature. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name: 5r oOA Z;y Date: Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application _ FOR OFFICE LSE OyLv City of TigardEReceived q �l/ �` `J g v Date/By: / 7 I Permit No.:' L It ga6,—/�3S7_ 1. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19613 E P 7 2016 01 Date/By: Other Permit: U Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov CITY OF tGARD Notified/Method: Supplemental Information BUILDING DIVISION COMMERCIAL FEE* SCHEDULE -USE CHECKLIST TYPE OF WORK Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0.3-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 JOB SITE INFORMATION rID LO •ATION Heating/cooling: / Air conditioning 46.75 Job site address: ''' 5"-:3C) ��f/�� • p Furnace 100,000 BTU(ducts/vents) 46.75 City/State/Z)P�� c C.- /�' 9C7Z� Furnace 100,000+BTU(ducts/vents) 54.91 Cr �- Heat pump 61.06 Suite/bldg./apt.no.: Project name: i ,, 11; tek Duct work 3 23.32 Cross street/directions to job site: trj ...,. c' 't' Ci L Hydronic hot water system 23.32 �� v•-e,--.5 Residential boiler(radiator or (:j cAr;a1,-. On /44 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 1—.. 23.32 _ L DESCRIPTION OF WORK Gas fireplace/insert 33.39 e�� Flue vent for water heater or gas 6v11ve- ni t7, 1,S ti / ,C k.`"l "� fireplace 23.32 G m �- I �✓ \ Log lighter(gas) 23.32 �J�' T � Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 }'VPRO ERTY OWNER o "TENANT Other: 23.32 Environmental exhaust and ventilation: Name: A, �t" � 3t (1-7?") Range hood/other kitchen Address: l3 1} Ft, , re O equipment 33.39 �_. 11 ' p Clothes dryer exhaust L 33.39 I City/State/ZIP: G ci � CA, Y Single-duct exhaust(bathrooms, .�/ toilet compartments,utility rooms) 1- 23.32 Phone:(503) 3 _ )f q ?_2 D - / 3 d Fax:( ) Attic/crawlspace fans 23.32 ;.., Vf PLICANT 0 CONTACT PERSON, Other: 23.32 Business name: A.Ca t ...A , i - L;/01re JC /(-- Fuel piping: !--'t L $14.15 for first four;$4.03 for each additional Contact name: 5 Cei 01.. A.ZZC) Furnace,etc. Address: l9 i Q/� J,,1G,)/sc�n Cu/a a e Gas heat pump t Jtf ✓`- Wall/suspended/unit heater City/State/ZIP: 1_4„1UVjCt �� 0 Water heater y Phone:(5Cyc5) L 5 .y I .3c Fax::( ) Fireplace E-mail: t Range YG t_lo utsy UCesacce.tt( - .41 Barbecue CONTRA R Clothes dryer(gas) Business name: Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: SL ��1 u Date: ../7.7A, I:\Building\Permits\MEC_PermitApp_040113.doc 440-461OM/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 r - I Electrical Permit Applicat ro►z 01:1:1(1: Isl,oN►.N Received City of Tigard SEP 7Perm"' 13125 SW Hall Blvd.,Tigard,OR 97223 20�� Date/B : 9 b �jT�l�—r�J�3s�- g Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503.0:11800 r'. �V!§,�8�� Date/B Inspection Line: 503.639.4175 Read Date/By:: loris: ® See Page 2 for PBUILDING Y Y S T I G A R D Internet: www.tigard-or.gov DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New constructionet-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. El Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. izi)-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived � `_ 0 Addition of new motor load of system. Job#: Job site address: t r�., C ^G i�� ' i 100HP or more. ❑ Ci /State/ZIP: ` O q T ❑Six or more residential units. occupancy. City/State/ZIP: ` t ��t' y / ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ,..3/ /1'')C 1 r\ ❑Hazardous locations. ❑Supply voltage for more than �-. 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: P O• VW 1—q_ -j �, e rs r FEE SCHEDULE 14, I L •\ t re... A- le-65 0 2 e YYYV„(_. Description Qty. Each Total / New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less *. 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 tive r r 1.5'exCC� I,S ' I/Zy Limited energy,multi-family 75.00 2 v �- rrovi ` ,,b residential(with above sq.ft.) '' , PROPERTY OWNER' / 0 TENANT Renewablr Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name:, 1 �'. ��v/��,) 200 amps or less �„ 100.70 2 Address: ./N:50,...-.5.514) L/� / 'h/f ; 201 amps to 400 amps 133.56 2 / 401 amps to 600 amps 200.34 2 City/State/Z1400-4t y Z,_ZS 601 amps to 1,000 amps 301.04 2 Phone:(56 3) 3 / ,,A0 Fax:( ) Over 1,000 amps or volts 552.26 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 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with C Business name: ph G c� 1/(411.1(r5 LLQ.. above service or feeder fee, J 7.42 2 each branch circuit _ Contact name: Cl+t cy e-L Z .) B.Fee for branch circuits without d � �,� / �� service or feeder fee,first 56.18 2 Address.///3 n c -'j,�, . branch circuit ) �� Each add'1 branch circuit 7.42 2 City/State/ZIP: �4 r 1 0 tt y� 9 76� Miscellaneous(service or feeder n t included) Phone:(5()) _, .T 3✓ Fa : :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: c t t it ikr Ve j/t u res 6Yl`x.l. , �0 Reconnect only 67.84 2 CONTRACTOR-/ITS Pump or irrigation circle 67.84 2 - Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0See Page 2 2 Address: g panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/z hr mm) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: 4,1 -1_7 Date:' 1///// . days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Description Qty. Each Total • 3' Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 El Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ID Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Vz hr min) ",;: .. :,:ELECTRICS PERMIES 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 ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n 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 L . Plumbing Permit Application Building Fixtures EE \j ED City of Tigard Received / 4, �� ?�- ll (��C 9 7 ii Il 'J Permit 1.16,7V0/60 7 111 g 13125 SW Hall Blvd.,Tigard,OR 97223 SEP f ZU U Date/By: fC Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: Inspection Line: 503.639.4175 ` Date/By: T I G A R D CITY F I l ate Ready/By: lads: ® See Page 2 for Internet: www.tigard-or.gov �'9 �� 6 a 91tt 1,:-.)i� otified/Method: Supplemental Information TYPE OF WO !� ��3 FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist. Description Qty. Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 V1.1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: l S-0 ...3[.., rt, I+\ S�1 re_-,r Catch basin or area drain 18.76 l Drywell,leach line,or trench drain 18.76 City/State/ZIP: 1 c-t%- ( Cy 1-7 Page/ ? Footing drain(no.linear ft.:_) Pa e 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: /1J-it Ilk LJ* Cr t� ' . {r---1e_ Manholes 18.76 ‘-I---r, C-C^G.C.. . f i 11 --t re i � � Rain drain connector 18.76 6 r\ 7 --- --- ( t Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer i31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 7 25.02 ("c).(--)Li e ''� C K l% t Ci G u 15 Dishwasher 25.02 r Kt. .f ��/� L 1 ( - r~ C Drinkingfountain 25.02 Ejectors/sump Z 25.02 7 ,•.PROPERTY OWNER 0 TENANT = Expansion tank 12.51 Name: Fixture/sewer cap 25.02 j�� Floor drain/floor sink/hub 25.02 Address: (� `� //� 1 re Garbage disposal 25.02 City/State/ZIP: g72z �` l ! Hose bib 25.02 Phone:( j) j4 ._ 77 Fax:( ) Ice maker 12.51 �G�T APPLICANT Interceptor/grease 25.02 ❑ CQNTACT PERSONtrap �• [� Medical gas(value:$ ) Page 2 Business name: ix V'01 z...,l '� " r (�6 e.5 Primer 12.51 Contact name: �Le` c%.'17?.. Roof drain(commercial) 12.51 Address: ) q '�o , �C!!l c�n ,,1-,e.i J(,_ 01 v.p` Sink/basin/lavatory 25.02 Z City/State/ZIP: 4-0,!/,<,r. W., 0 g`,C/� Solar units(potable water) 62.54 Phone: (5- ,) .Fe.„, S V ` Fax :( ) Tub/shower/shower pan ! 12.51 E-mail: t Urinal 25.02 CONTRACTOR Water closet / 25.02 Water heater 1 37.52 f Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name / Date: 7 This permit application expires if a permit is not obtained within 180 days �� ( cafter it has been accepted as complete. G., ,�Z,� "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 t2 ; Fee(ea) Total Square Footage: Permit Fee: Footing drain-1'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation; Permit Fee. .7. Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qt. 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 Plin 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 engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser.Diagram 4" 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: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard IIq• COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: MST ac) (_ OC3 g` ..a Site Address: 13S30 SW -Hi'11 ,,Sh; lr. Dc. Project Name: S(M011 Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: r n4e, r Go n trees i o (1 N e'W ditch../ 1 Gl r) tiVi +0 A abis Ct-I w i _spa t2 Verify site address/suite#exists and active in permit system. , River Terrace Neighborhood: PKNo ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan ,xisting structures on site Aite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished rawn to scale(standard architect or engineer scale) floor elevations orth arrow 3'locations (required for new,may apply for additions) Aite address,project or subdivision name and lot number --❑.Lesition of wells/septic systems 4,0 pplicant information(name and phone number) tg trees to be retained with drip line,and tree Lot dimensions and building setback dimensions protection measures Lot area,building coverage area, ercentage of coverage and entree size,type and location / tmpervious area(applicable if)R-12,R-25&R-40) Street names Property corner elevations(2 foot contour lines if more than 4 foot differential) 'Agf Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No / Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake ...e—tarid Use Case#: 1 Zoning: 2-i gi Setbacks: Front 1 S Rear 1 5 Side ,rg Street Side I'D Garage Z 0 0 Landscape Requirement: ,2•0 0/0 ,P1 Lot Coverage Maximum: S 0 % g'Building Height: Maximum Height ?S Actual Height /7 Visual Clearance Easements gp Sensitive Lands: CI Yes El No Type �`-J Urban Forestry Plan zConditions "Met"prior to issuance of building permit Notes: Approved By Planning: 44 ` Date: (// 7 /),6 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: El Approved El Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Submittal / Original Submittal Date: 9h 4 Site Plans: # 3 Building Plans: # 3 Building Permit#: 12—Enter building permit#above. Workflow Routing: a Planning Engineering E Permit Coordinator uilding Workflow Sign-off: Er-Sign-off for Planning(include notes from planning review) Route Application Documents: V Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. /Buil_ding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: n� / By Permit Technician: 6D,�,�e_IC Date: �-1'/7l Ifo Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 1, eIL Date: q-g.--z Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes , "2Q/A jT``--�� Tigard Trans SDC: ❑ Yes 2'N/A Parks SDC: ❑ Yes N/A rmi?eOK to ::: :ordinator: l, /J APP oved Date: 1//�/ I:\Building\Forms\B1dgPennitRvw_RES_060116.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13530 SW HILLSHIRE DR, TIGARD, OR, 97223 April 21 , 2017 at 11 :38:14 AM Record Type: Record ID: Residential - Master Permit MST2016-00352 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Note: bath fan switch to be timer or de humidistat. See building final inspection. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13530 SW HILLSHIRE DR, TIGARD, OR, 97223 June 12, 2017 at 7:57:38 AM Record Type: Record ID: Residential - Master Permit MST2016-00352 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: This inspection passed previously, see inspection dated 4/21/17. Picture provided to inspector Allison Armstrong for timer or de humidistat for bath fan. Violation Summary: Inspector Contractor