Permit CITY OF TIGARD � rgt MASTER PERMIT
COMMUNITY DEVELOPMENT f�Lf/ Permit#: MST2017-00033
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2017
Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Subdivision: None Lot: None
Project: BCS Batiment LLC
Project Description: 6/6/2017: REPRINTED to increase from 236 sf master suite addition and 156 sf entry addition,
and reduced deck from 1140 sf to 765 sf. 4/26/17: REPRINTED permit to include(1)tankless
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 392 sf Basement: sf Left: 5 Parking Spaces:
Height: 24 Bathrooms: 1 Second: 0 sf Garage: sf Front: 20 Smoke
DwellingUnits: 1 Detectors: Yes
Third: sf Right: 5
Total: 392 sf Value: $61,233.60 Rear: 12
PLUMBING
Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 0
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 2 Hose Bib: 1 Backwater Value: 0
Drywell-Trench Drain: 0
Other Fixtures: 1
Other Fixture Units: Water piping/DWV
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 7
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 12
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 392
Owner: Contractor:
BCS BATIMENT LLC BCS BATIMENT LLC Required Items and Reports(Conditions)
SKYTERA LLC 19705 SW 65TH AVE
19705 SW 65TH AVE TUALATIN,OR 97062
TUALATIN,OR 97062
PHONE: 541-337-8306 PHONE: 503-619-7070
FAX:
Total Fees: $2,348.97
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 •'R• -011-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
\ /
Issued By: ! , "� � �
% !'� _ Permittee Signature: � �"�4� C, "7�p!`v/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
,' 1S48 ,(-:
Building Fixtures "' FOR OFFICE USE ONLY
City of Tigard «e Eie41"
PermitNo/ /� , 0L y3III13125 SW Hall Blvd.,Tigard,OR 9 Jw
Phone: 503.718.2439 Fax: 503.598.1960 • -4, Other Permit No.:
Inspection Line: 503.639.4175
1 I G A It D
���� 8 Steady/By < Juns. Ei See Page 2 for www ti and-or. ov ted/Method: Supplemental Inf
ormation
e "-11114-.. ,hi ii ' � t"�� „ 4-4-',j'ifhgib ESE1�� " I�y� � �
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I�! e% 0,4 ��w i1 ,-, x, �' 1W05Emm�-. d :.1;f--,--,,, _ _ ' e�rm., > . �'. ,- � �i� ary"m ,
['New construction ❑De For special information use checklist _
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑OY New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORYOF CONSTRUC TIQAI r V)iiiy, ". ,�.,ill SFR(1)bath 312.70
®1-and 2-family dwelling I:]Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
SI", INFORMATION ALrocATIO i� , "" Site utilities:
,17-1,00J-JOB- ..,..,,,„,,,,,,o'- _,,,,„,,,,,,,,N,----l .-. aid�1
Job site address: 13185 SW 115`1i Ave Catch basin or area drain ]8.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 115`h Addition Manufactured home utilities 50.03
Cross street/directions to job site:SW Fonner St Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: 110 Fixture or item:
Tax map/parcel no.:2s-lw-03-sw-ne Backflow preventer 31.27
x - h
DESCRIPTION ,-24,449,11;1%;,,. ,r " pill
Clothes washer 25.02
Add icemaker and sink for lower level to permit MST2017-00033 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
"' ® PRO' RTY O i+R: i ❑ vkl,-; ,, 11,, Expansion tank 12.51
Name:BCS Development LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 19705 SW 65th Ave
Garbage disposal 25.02
City/State/ZIP:Tualatin,OR 97062 Hose bib 25.02
Phone:(541)337-8306 Fax:( ) Ice maker 1 12.51 12.51
API",RANT- mt� 'V' , ; ' �0 CONTACT PERSSON: Interceptor/grease trap 25.02
14lid „ i ,. �.....
Business name:BCS Batiment LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Caitlin Kjemperud
Roof drain(commercial) 12.51
Address: 19705 SW 65th Ave Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54
Phone:(541)337-8306 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: bcsbatiment@gmail.com Urinal 25.02
1.11 'i 7 - ,441,j,', ONTRA 1d '4`4 ;i"i,,lo . Water closet 25.02
Water heater 37.52
Business name:H&H Mechanical LLC Water piping/DWV 56.29
Address:5757 SE Willow LN Other: 25.02
City/State/ZIP:Milwaukie,OR 97267 Subtotal 3v,53
Phone:(503)975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 178122 Plumbing Lic.no.:PB414 Plan review (25%of permit fee)
State surcharge(12%of permit fee) rsO
Authorized signature: Caitlin Kjemperudfl, °,n,,•,mm74 -mm°°-'- TOTAL PERMIT FEE 6.02
Print name:Caitlin Kjemperud Date:12-6-17 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
signing as applicant for BCS Batiment LLC
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
,pq . CITY OF TIGARD ,. ' 1 MASTER PERMIT
COMMUNITY DEVELOPMENT MEM Permit#: MST2017-00033
T1GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2017
Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Subdivision: None Lot: None
Project: BCS Batiment LLC
Project Description: 6/6/2017: REPRINTED to increase from 236 sf master suite addition and 156 sf entry addition,
and reduced deck from 1140 sf to 765 sf. 4/26/17: REPRINTED permit to include(1)tankless
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 392 sf Basement: sf Left: 5 Parking Spaces:
Height: 24 Bathrooms: 1 Second: 0 sf Garage: sf Front: 20 Smoke
Dwelling Units: 1 Third: sf Right: 5
Detectors: Yes
Total: 392 sf Value: $61,233.60 Rear: 12
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Water piping/DVW
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 7
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 12
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 392
Owner: Contractor:
BCS BATIMENT LLC BCS BATIMENT LLC Required Items and Reports(Conditions)
SKYTERA LLC 19705 SW 65TH AVE
19705 SW 65TH AVE TUALATIN,OR 97062
TUALATIN,OR 97062
PHONE: 541-337-8306 PHONE: 503-619-7070
FAX:
Total Fees: $3,391.29
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
952-001-0010t •r•h a 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.80+ 32.'44.
Issued �/// Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection d . I
This permit card shall be kept in a conspicuous place on the job site until comp): ion of the project.
Approved plans are required on the job site at the time of each inspection.
•
City of Tigard
■ ill COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
1IGAKl3
Building Permit #: / 57j 7—Lxx) '
Site Address: t 731955 Si j s Av&
Project Name: 1.5-41 Ave, A4(id-it,, Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: A M L.tiw
*Verify site address/suite#exists and active in permit>if—River Terrace Neighborhood: ArNo 0 Yes,See River Ten-ace Review Addendum Attached
Si a Plan Elements:
Three(3)copies of site plan %c :sting structures on site
ite plan guest he on 8-1/2"x 11"or 11 x 17"paper ,_4 Footprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow )5IJtility locations(required for new,may apply for additions)
)ittite address,project or subdivision name and lot number l'illALocation of wells/septic systems
applicant information(name and phone number) sting trees to be retained with drip line,and tree
,ot dimensions and building setback dimensions rotection measures
���,,,��,,
tia.Lot area,building coverage area,percentage of coverage and et tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) '14 treet names
NProperty corner elevations(2 foot contour lines if more than
foot differential)
"gi Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: R"Yes,applicant was notified 0 No Received: 0 Yes eNo
Public Facilities Improvement(PFI)Permit
Required: 0 Yes,applicant was notified _a No Applied For: ❑ Yes 0 No,stop intake
ET Land Use Case#: L-L-A A 1(o-coo(p
.s' Zoning: 1 14.S
Required Setbacks: Front 2_0 Rear / Side 5 Street Side !. Garage 20
Landscape Requirement 1\1f4 % (4›-A1>T 20LID a it—1
Lot Coverage Maximum: NCAA.
Building Height Maximum Height ' DI
Actual Height c?Q/
,� Visual Clearance 0 f
Easements
{.Sensitive Lands: 0 Yes A No Type
IV Urban Forestry Plan
'NConditions"Met"prior to issuance of building permit
Notes:
Approved By Planning: .=_ Date: //QS/9.
Revisions(after B 'lding Submittal only) . er Date
/Revision 1: Approved ❑ Not Approved %i '' -la�� f� 6 /30/ (2
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
Building Permit Submittal
Original Submittal Date: t7,1-,j`j
Site Plans: # 3
Building Plans: # _
Building Permit#: lr]''�` tteer building ppermit#above.
Workflow Routing: [ 1a ning TV-Engineering ermit Coordinator ceding
Workflow Sign-off: alin-off for Planning(include notes from planning review)
Route Application Documents: gineering (1)copy of permit application,(1)site plan, (1)building plan and
orig+pal plan review routing form.
uilding original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: #0,04-7.4, 5 --- Date: ,14-17
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: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 Yes 0 No
❑ NOT Approved by Engineering. Date: ,
Notes:
•Approved by Engineering: ___IL Date: /....z4.--t7
Revisions(after uilding Submittal only) Review to
Revision 1: Approved 0 Not ApprovedL' —11 .-- 7
Revision 2: Approved 0 Not Approved
Revision 3: 0 Approved 0 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 1
't: DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes N/A
Tigard Trans SDC: 0 Yes N/A
Parks SDC: 0 Yes N/A
CO'OK to Issue Permit /
Approved by Permit Coordinator: n Da
1:\Buildmg\Forms\BldgPermitRvw_RES 091216.docx
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 Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: tana°L • DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVE])
FROM:
C� n11 ( •r\46 MAY 30 2017
COMPANY: 1351111Xleank CITY OFTIGARD
PHONE: S4-1 - X37 (Z3- 511) BUILDING DII/ 1( 1•
RE: \31 n ri6 -Tiyyd MST 2N7 - bbo
(Site Address) (Permit Number)
.Add it in I ci t---4c- 1 l Z)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
3 Additional set(s)of plans. 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):
REMARKS: 1n put o f ?75 we, w \1
wii‘ditA an &inclosed sovt ci of \nac -me r\mi
eniiN cc t
Routed to Permit Technician: Date: Initials:
Fees Due: • Yes ■ No Fee Descri.tion: Amount Due:
Special
Instructions:
Re.rint Permit .er PE : ❑ Yes ❑No ❑ Done
A..licant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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.
1)4
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: tG1nn CL . DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVE!)
FROM: kit 1 'n \ -FM peter V d MAY 3 0 2017
COMPANY: CIT'OF TIGARD
PHONE: SIA-1 BUILDING DIV�S �P
B :
RE: \92k Sw 11c .•T ayd Ms-t 21-517 -- b(DO.
(Site Address) (Permit Number)
I 1 �1 -A [3 LYl \ cit- 11 O
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
_x � � ..�'.�, f: � - � ,-.}3. � ... •„ � -�'� �'�;,
�
3 Additional set(s)of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations�/f,ll7 f Engineer's calculations.
Other(explain): 514 /� �— // iO - 3 7 S _ 74 S
REMARKS: \r\ ptaU 0' :75 - c -e.. sur' CC ) we, W\1
. ► l tL • •tel '.1d i� V1. e , lit I:
0)&AkA Armco !� • o yes a m xld d e
5 - =- /�1 t % .4 A . •7-1. • I
Routed to Permit Technician: Date: -,j — ) -7 Initials: ,
Fees Due: ill Yes Ei No Fee Description: ount Due:
r
Special
Instructions:
Reprint Permit(per PE): � Yes ❑No Done
Applicant Notified:C4,rt,,tJ Date: w �//7 {n><tials:,`rv
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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
Tr •
os
_ Transmittal Letter
, , 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: t OP() DATtektirED
DEPT: BUILDING DIVISION
FROM: I(�Y1r10�1 S-C1)=--t,Li JUN 2017
CITY OF TIGARD
COMPANY: VC5 tl\l'�-e.' t U-� BUILDING DIVISION
PHONE: 27�i U By:
RE: 1`aS`N \\ h P\vZ . tOiNkia) OP - j-AS\7-0\1-00( 5-3
(Site Address) 01`1 1:L2) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Additional set(s)of plans. X 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):
REMARKS: S v) 2 tt1-1 kk 1 rk.-V` c,1 o In c>, Sk.r . ;vcU Ukt c u l CI 0 r 5
G. vc 5 3 L , 5 ave r iN to cel- of rtia tivin9 S
Routed to Permit Technician: Date: G--
Fees Due: Ly Yes • No Fee Descri stion: Amount )ue:
,,. IIMPIMEMIMPIMIMMII $ 0
$
$
$
Special
Instructions:
Re.rint Permit ser PE : EAt. � o Ij Done
A. slicant Notified: 04/774 t/ Date: MA�7 �
I:\BuildineForms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD MASTER PERMIT
,' Permit#: MST2017 00033
I ' COMMUNITY DEVELOPMENTIII
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 j;. .
Parcel: 2S103CA00101 Date Issued: 03/30/2017
T r G A 9
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Subdivision: None Lot: None
Project: BCS Batiment LLC
Project Description: 236 sq. ft. master suite addition. 4/26/17: REPRINTED permit to include(1)tankless water heater
with gas piping. 5/1/17: REPRINTED permit to include(10)branch circuits, (1)water heater
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 236 sf Basement: sf Left: 5 Parking Spaces:
Height: 24 Bathrooms: 1 Second: sf Garage: sf Front: 20 Smoke
Dwelling Units: 1 Third: sf Right: 5
Detectors: Yes
Total: 236 sf Value: $52,030.20 Rear: 12
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 7 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 7
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add''500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 12
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 236
Owner: Contractor:
BCS BATIMENT LLC BCS BATIMENT LLC Required Items and Reports(Conditions)
SKYTERA LLC 19705 SW 65TH AVE
19705 SW 65TH AVE TUALATIN,OR 97062
TUALATIN,OR 97062
PHONE: 541-337-8306 PHONE: 503-619-7070
FAX:
Total Fees: $2,616.78
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 enter. Those rules are set ,(Orth in OAR
952-001-0010 through OAR 952-001-0090. ,u may nbtain a -= - -- les or direct questions to OUNC by calling 4j 1987 o. 1332.2344.
Issued By: ,6‘ tt Permittee _..... 20
.•39.4176 by 7:00 a.m.for tie text available inspection •• e. 1
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
Mechanical Permit Application 1012 01 11ci t's:ONLv
Cl of Tigard Received Permit No.: �.} ,
`J g 1 .' ,t, Plan
/^7J/ 2di,7"�V3)
�;%
i
1
tlocuSan Envelope l3:8B64EE23-F02B-4E0A-B6E1-38AB5F131ACA "`yf 1.Olt O11hi('1:I:SI:O\I.I '
City of Tigard '' ReceivedIIMBIEEMEMIET
• 13125 SW Hall Blvd.,Tigard,OR 97223' '4 •, Plant Review •
Phone: 503.718.2439 Fax: 503.598.196 r+ ',.'i 1 D. , • Related Permit#:
Inspection Line: 503.639.4175 i\N, . •Salty Date/By: Awls: El See Page 2 for
V I(.A R1 Internet: www.tigard-or.gov Nddfind/Method: Supplemental information
TJ UT WORK (t@` s .�,' r .: PLAN REVIEW
❑New construction ,Addition/aiteration/re�le8eilacrif- .. 4' Please check all that apply(submit 2 sets of Ions w/items checked
si PPY _ P )
r 0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other; ,IN where the available fault current 0 Marinas and boatyards.
CA'>t'E?ty#RV O1 CONSTR IC(1ON; exceeds 10,000 amps at 150 volts or ❑Floating buildings.
,1-and 2-family dwelling 0 Commercial/industrial 0 A,cess.- .uilding * less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
3011 SrrE'mLFORMAT oN A 4D;LOCATION, , ,T,'". ." ❑Emergency system• larger separately derived
Job#: Job site address: � 6 , f � ❑Addition of new motor load of system.
6;g1NiOOHP or more. ❑"A" "E","1-2""1-3"
bizCl —+-y ['Six or more residential units. occupancy.ty/St2tC/ZIP: 1 l ' ( ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#' ❑Hazardous locations. 0 Supply voltage for more than
Project name: f
�� ' ' `' ❑Service or feeder 600 amps or more, 600 volts nominal.
Cross street/directions to job site: _ P - DtE„ ' ,r n : r,
('�( f. _( ac
� Description I Qty. 1 eh I Total
T �Jnei ' -( New residential single-or multi-family dwelling unit.
Subdivision: vv/, , Lot#; 0 0 Includes attached garage.
•Tax map/parcel# 1,000 sq.R.or less 168.54 4
(--(Y, »� Ea.add.'500 sq.ft.or portion 33.92 1
' �h ra� ���!si s.r�i
sig , .. .` -fe
�..�ii �. ' *P'� ! " nV�. i,., Limited energy,residential 75.00 2
ni I 4 f. `✓-, ( 1/45'( 4 ((��� (with above sq.RJ
A ( — �,,Y �y f ,- Limited energy,multi-family 75.00 2
IJlll�vri � �}"Y/ `�►! residential(with above sq.ft.)
l-I Renewable Energy ❑ 3ee Page 2
' ` Pi10'1 "I`lr, `,::::,•:,4',• " Ao" Services or feeders installation,alteration,and/or relocation
Name: r(-J` CIY r ., 200 amps or less 100.70 2
Address:i C' `�✓J "CCCCJ/J/"�"" r � „ 201 amps to 400 amps 133.56 2
SW ���llln///ciVI /-F'\/�� 401 amps to 600 amps 200.34 2
City/State/ZIP. i�F JN. � 601 amps to 1.000 amps. 320001..04
2
Phone:(3-1-1)' 7-401 Fax:( ) Over 1,000 amps or volts 552.26 2
^ hn`� �l Temporary services or feeders installation,alteration,and/or
Email: -' i i tit,! tr relocation
Owner installation:This installation is being4nade 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
7 xq �. Ap�ibt��1� xi, Branch circuits—new,alteration,or extension,der panel
„„,„ s.. _ ) �� *.LI �,h�,w��: A ,t .�) aOtvrl T�+k ! ? j� t ,;R '°a.. A.Fee for branch circuits with
_Business name: (ry y� �- . ›Aft �p 1`u„e above service or feeder fee, 7.42 2
"YY i� each branch circuit
Contact name:( - t f ' ..?..i.e, ,, a B.Fee for branch circuits without
v�` service or feeder fee,first 56.18 2
Address: C' i
�� _ � branch circuit },
City/State/ZIP: a I 1/1 *7 2.-, Each add'l branch circuit l0 ,(/� 7.42 '7 2 it 1"
.�.,r ZI t Miscellaneous(service odfe r not included)
Phone: ) l`,. --ea • , Fax::( ) Each manufactured or modular
1 dwelling,service and/or feeder 67.84 2
Email: h//i,19V1 • t1 1 'r• (.., Reconnect only 67.84 2
Y�4�/ -w wise t�
;,'",,;'•. : '..„ . K, . '' ' s tt.t o u r M Pump or irrigation circle 67.84 2
Business name: Tesla Electric Company Sign or outline lighting 67.84 2
2850 Cedar Hi l s BLVD #250 Signal circuit(s)orlimited-energy 0 See page2 2 '
Address: panel,alteration,or extension.
City/State/ZIP: Beaverton, OR 97005 Each additional inspection over allowable in any of the above .
Additional inspection(1 hr min) 66.251 hr
Phone:( ) 503-705-2285 Fax:( ) Investigation(]hr min) 90.00/hr
Email: test apdx@gmai 1 .com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 189699 Electripalloig,48 ,9g: Suprv.Lie,: 46975 specifically listed(%hrmin)
1t1 ,,i J'1/ EtteIta At,Aflt'E1ilgrr:>~g S
Suprv.Electrician signature,requirei:W1W61141 Okir '(1 Subtotal: 7-J,
Print name: Wi 11 i am w whi rOsr—Eesa7Da688c3481... Date: 3/30/2017 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 0.4//'
Authorized signature: .,'y, ' , TOTAL PERMIT FEE:
tt This permit application expires if a permit is not obtained within ISO
Print name: VT' , Date: t/ 1 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\PermiUtELC_PermitApp ELR ERE.doc\Re 06/17/2014 4404615T(II/0/COM/WEB
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: /y)s7,. 17 q, e'�
11111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review O�/ ZJ
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
s
❑New construction ❑Demolition , , ' J�:�
For special information use checklist
jtl
1Description Qty. Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
/-
/ SFR(3)bath 500.32
❑Accessory building El Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: -i<65 j j ' t\c 1Y\ Catch basin or area drain 18.76
Drywell,--\---\
\, A i 972_2_ leach line,or trench drain 18.76
City/State/ZIP: Y
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: `\E Y) _f=Ato6,t,AS Cl 1 Manufactured home utilities 50.03
Cross street/directions to job site: E.:3\ N-7----ENCVAC Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:IOD) 1 Page 2 C„t,5-1j
Storm sewer(no.linear ft.: ) Page 2
0 Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: I l Fixture or item:
Tax map/parcel no.: 2- - 1y\/-- 03 ,� c^y,n g _/v„ Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer ] ;5-.02,25.0 ;5-.02,/
Dishwasher i` 25.02 ;s7,0;,.,
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER a 0 TENANT Expansion tank 12.51
Name: U,ek, \ �� Fixture/sewer cap 25.02
�!
Floor drain/floor sink/hub 25.02
Address: V)110 ) { � )-5":6;_
Garbage disposal 1 25.02
��
City/State/ZIP: .1 lig or V tV L- Hose bib I 25.02 01-5,,:,r
Phone:ma 1 ) 3 Fax:( ) Ice maker I 12.51 0...5
{ APPLICANT z . 0 CONTACT PERSON ': _; Interceptor/grease trap 25.02
Business name: US 00j--Malt 1 A i� Medical gas(value:$ ) Page 2
n ' (�� Primer 12.51
Contact name:
�� Roof drain(commercial) 12.51
Address: kg-70c) S 1 V �/ Sink/basin/lavatory 5- 25.02 8 AS,/0
City/State/ZIP:- al /NZ Solar units(potable water) 62.54
Phone:/),.?). --7-
2) 7- � Fax::( ) Tn /� Tub/shower/shower pan131 12.51 )s'.e ,
E-mail: �� "\(r1ix^�L • l.i V . Urinal 25.02
t , Water closet 25.02 SO,v q
, ' ; ;,� It CONFRA#CTO
Water heater 37.52
Business name: 4.1. M- *1 ?l 1. C& ' jL/ Waterpiping/DWV 1 56.29 „A
Address: �'- 7 5 7 -S \Ai 1 C/N/NC � 1 Other: I 25.02 '
City/State/ZIP: 1\ lioa,F-,l(l -(, / re cl 7 7(.0-7 Subtotal 'I3% S'
Phone: 53' ( 7c -C�7 e)-7 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
---7 J
CCB Lic.: I /F) i Plumbing Lic.no.: 4
��, State surcharge(12%of permit fee) 5/.•7 IAuthorized signatu 'aa : //' ' TOTAL PERMIT FEE xJ 7
---777 This permit application expires if a permit is not obtained within 180dais
Print name: t Dates- f / after it has been accepted as complete.
/ *Fee methodology set by Tri-County Building Industry Service Board.
t^�z
sCSS CP p� -�" � c
L\But mg\Permits\ -PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty• Fee(ea) Total Square Footage: Permit Fee:
Footing drain-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Tota
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial CI Any multipurpose fire sprinkler system.
Domestic 0 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
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
r CITY OF TIGARD II
f` MASTER PERMIT
COMMUNITY DEVELOPMENT IFI&7Permit#: MST2017-00033
Date Issued: 03/30/2017
T E GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Subdivision: None Lot: None
Project: BCS Batiment LLC
Project Description: 236 sq. ft. master suite addition. 4/26/17: REPRINTED permit to include(1)tankless water heater
with gas piping.
~ BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 236 sf Basement: sf Left 5 Parking Spaces:
Height: 24 Bathrooms: 1 Second: sf Garage: sf Front: 20 Smoke
Dwelling Units: 1 Third: sf Right: 5
Detectors: Yes
Total: 236 sf Value: $30,000.00 Rear: 12
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
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: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 236
Owner: Contractor:
BCS BATIMENT LLC BCS BATIMENT LLC Required Items and Reports(Conditions)
SKYTERA LLC 19705 SW 65TH AVE
19705 SW 65TH AVE TUALATIN,OR 97062
TUALATIN,OR 97062
PHONE: 541-337-8306 PHONE: 503-619-7070
FAX:
Total Fees: $1,717.56
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 rough OA' ! 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin 03.232.1987 or 1.800.332.22344. /n/
I
Issued By1 j� _ . ,'///,.....4_,A , Permittee Signatur _40-1,7/�YL�Y
Call 503.639.4175 by 7:00 a.m.for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE usr:()NIA
ill m City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
■ Phone: 503.718.2439 Fax: 503.598.19 Y ,' Plan Review
' ,DatePlan Re: Other Permit:
7'i U A R D Inspection Line: 503.639.4175
CE Date Ready/By: Jurist ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
ATYPE OF WORK ) 2��5�6 COMMERCIAL FEE* SCHEDULE-- USE CHECKLIST
❑New construction Addition/altera,o a( +�.CA� Mechanical permit fees*are based on the value of the work
�' ° performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: 11�L 11'4 DIVISION mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OP" CO STRUCTION Value:$
.�e, RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
§1-and 2-familydwellinga
❑Commercial/industrial 0 A hr1.' For special Information use checklist.
0 Multi-family 0 Master builder 0 0 It ` Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATI`a Heating/cooling:
Air conditioning 46.75 site address: 1' i( SSr^( t \ -{v\ Furnce 100, 00
BTU(ducts/vents) 46.75
City/State/ZIP: I \ ��(�J ( ,_ 0j Z', Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: \.\ t sx- Heat pump 21.32
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
^,� p Residential boiler(radiator or
Y v ` 'e.y+ hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
(`d) admit 6)laikicsi i, T- p,p, lb Flue/vent for any of above 23.32
Subdivision: Other: 23.32
T
`�� OJ 7 Lot no.:
12)
Other fuel appliances: 1"
Tax map/parcel no.: 26 -1,w * 'y- c, ,YV Ne..- Water heater ) 23.32 'VL 3i.
DESCRIPTION OF WORK Gas fireplace/insert 33.39
��t` ,�,,y' Flue vent for water heater or gas
e�✓1 f t6G 1, ( ).63. �t ,(. ..9:5... .,..5\.e
(` `2I - fireplace 23.32
C ~�~� \ ( , Log lighter(gas) 23.32
�y� Y J ....i."...
J� � Wood/pellet stove 33.39
t�\� 1 '( l-(' 2Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Vit PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:Name: ECS1, ),f,e .Qrw-n) Range hood/other kitchen
1CnC5 , r equipment 33.39
Address: \ r
(� /� j 'v `�e
Clothes dryer exhaust 33.39
City/State/ZIP:�t -CICk 1 1� / CNN_ {V)� Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone: I) Fax:•
( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: / ? ,/V,j , Fuel piping:
/J1 I J v' v $14.15 for first four;$4.03 for each additional
Contact name: rt ]'n2\ropeinAd1 vl Furnace,etc.
Address: 10 De C"�/\I . /p• Gas heat pump
I `� r .�A.,/e, Wall/suspended/unit heater
City/State/ZIP: I D j/ , Water heater ( 1L , ,
Phone: ��I)��^^`((//y�y 1122'611�` Fax::( L �) ��/� Fireplace
E-mail: Vl�art �1 V2A '1-2, littAl ' /4/1/1 V ' Range
Barbecue
CO CTOR Clothes dryer(gas)
Business name: "�er°reef{') aLS Other:
�!—� v' 1 wt (/� MECHANICAL PERMIT FEES*
Address: p®, r t3 06
Subtotal
City/State/ZIP:W1 s uhf cJ'7" (7 S Minimum permit fee($90.00)
/ ✓ Plan review(25%of permit fee)
Phone:5.e) 407 9542_ Fax:( ) State surcharge(12%of permit fee)
CCB lic.: i ,s 03 I �/ TOTAL PERMIT FEE
V This permit application expires if a permit is not obtained within 180
�/ ���-,. . days after it has been accepted as complete.
Authorized signal e: ►'o'/ ' r * Fee methodology set by Tri-County Building Industry Service Board
/ y^7
Print name: C /41��t• ' r Date:� i /
I:\Build' \permits C P itApp 040113. je, '`4 �t
440-4617T(i i 02/COM/WEB)
Plumbing Permit Application
Building Fixtures
City of Tigard itECEIliEt Received
3
13125 SW Hall Blvd.,Tigard,OR 9 Date/By: Permit No.: SP 7...,,,,-,3
1 • Phone: 503,718.2439 Fax: 503.598.1960 Plan Review
6Date/By: Other Permit No.:Inspection Line: 503.639.4175 inn 2°17 Date Ready/By: Juris: See
Pent 2 fnrliC AIti> Internet: www.tigard-or.gov Notified/Method: Supplemental Info
rmation
TYPE OF WOR ��$ OITIGA D
FEE* SCHEDULE
❑New construction f 11A1`G DIVISION For s ecial in ormation use checklist
-
Description Qty, I Ea, 1 Total
-$4Addition/alteration/replaeement I ter: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
/ti 1-and 2-family dwelling 0 Commercia SFR(2)bath 437.78
ttt
❑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 ANDLOCATION Site utilities:
Job site address: 111„�Js v "5 1_cr,‘ c...4e, Catch basin or area drain 18.76
City/State/ZIP: "j-`e1/4/c� , . 7 Z-z Drywell,leach line,or trench drain 18.76
�.J i Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: \\T • r• k\ '\ Manufactured home utilities
50.03
Cross street/directions to job site: Manholes 18.76
5i\i 1 O ^-- Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Ili) Fixture or item:
Tax map/parcel no.: 9. - l -e,,,,-\(\i .-fit✓ Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02Tti. DCZ 1p!C ( LDS �ia hAN�4' I' Dishwasher 25.02n�ictjeiiryV /t- MS+ 207 O0V
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER Q TENANT Expansion tank 12.51
Name: OOS pg/t/AWY1-0121--.pFixture/sewer cap 25.02
Address: 117 �La Floor drain/floor sink/hub 25.02
p� r�� h y� Garbage disposal 25.02
� 1/I(,(
City/State/ZIP: 1 i. Ul Hose bib 25.02
Phone:(S�-1) 3'37--. 2:, Fax:( ) Ice maker
`� 12.51
A. APPLICANT
CONTACT PERSON Interceptor/grease trap 25.02
Business name: C,I,S j31 L4....e..., Medical gas(value:$ ) Page 2
Primer 12.51Contact name: I ' %,.Jt-y\peqlnej
Roof drain(commercial) 12.51Address: 1GJ7 QVn1
•
Ale Sink/basin/lavatory 25.02
City/State/ZIP, n !� 0.-7O2.02- Solar units(potable water) 62.54
Phone: ) rj^"" " L j(O Fax::( ) Tub/shower/shower pan 12.51
E-mail: �.y Urinal
l.'W7��r/f til �-%C /1 -/!.. ti/ Y ' 25.02
CONTRA It
Water closet 25.02
Business name:1-1 f nihat Water heater I 37.52 `37 .
4 j' `°, `��1 Water piping/DWV 56.29
Address: S 1A/I ' I n Other: 25.02
City/State/ZIP: M( 1 wclu e, L rJ1.7'2/2 7 Subtotal
Phone' ) 975- 7E3 7 Fax:( ) !-kll Minimum permit fee: $72.50
CCB Lie.: i 7E, j 2_2_ Plumbing Lic.no.:p�4(T Plan review (25%of permit fee)
State surcharge(12%of permit fee)_
Authorized signatu, it � �._�fit TOTAL PERMIT FEE
Print name: �'t Date: This permit application expires if a permit is not obtained within 180 days
do [ 4 2S 171 y
/ after it has been accepted as complete.
eJ "7 '"`0 ��
LL( "Fee methodology set by Tri-County Building Industry Service Board.
:\Building\Pe ' LMU-PermitApp.doc 1011/099/ 440-4616T(10/02/COM/WEEBB)„
Branden Taggart
From: Caitlin Kjemperud <bcsbatiment@gmail.com>
Sent: Tuesday, April 25, 2017 4:37 PM
To: Branden Taggart
Subject: RE: Building Permit: MST2017-00033 - SUBS
Attachments: Hot Water Heater Plumbing Permit 4-25-17.pdf; Mechanical Revised 4-25-17.pdf
Hi Branden,
No problem.That makes sense.
Please see attached Mechanical and Plumbing permits showing the new gas line and hot water heater.
Thank you for the email and voicemail explaining the process. I hope this covers it and please let me know if you need
any additional information.
Appreciate the help!
Thank you,
Caitlin
BCS BATIMENT LLC
Caitlin Sinkey-Kjemperud
Project Manager • 541-337-8306
specializing in project development
From: Branden Taggart [mailto:brandent@tigard-or.gov]
Sent:Tuesday,April 25, 2017 2:50 PM
To: 'Caitlin Kjemperud' <bcsbatiment@gmail.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Building Permit: MST2017-00033-SUBS
Hi Caitlin,
Thank you for providing the forms. However, since you are adding the tankless water heater now, we will need you to
state this on the application and resend a new copy with the correct totals. Also, I noticed that gas piping was not
included on the permit for a new tankless water heater. We will need to add gas piping on the mechanical application as
well. Furthermore,we did not collect water heater fees on the plumbing application for the potable water
connection. A water heater will also need to be added to the plumbing portion of this permit fees. So,we would
appreciate it if you can also send over a plumbing permit application stating that you want to add to this work. To sum it
up, we will need the following:
(1) Mechanical permit application to add (1) water heater and gas piping for(1) water heater.
(1) Plumbing permit application to add (1)water heater.
1
I will add the$45.00 fee for changing contractors after we receive both the revised mechanical and plumbing permit
applications. I know this is a lot more complicated with the addition of the tankless water heater. Please give me a call
if you have questions.
Thanks,
Branden Taggart
11
q City of Tigard
r to `:,• Permit Technician
Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(503}715-2449
bra ndent@tigard-or.gov
From: Caitlin Kjemperud [mailto:bcsbatiment@gmail.com]
Sent:Tuesday,April 25, 2017 11:00 AM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermitsPtigard-or.gov>
Subject: RE: Building Permit: MST2017-00033 -SUBS
Hi Branden,
Please see attached. I signed the new mechanical permit application as the applicant. Please let me know if Evergreen
needs to sign it.
The work is staying the same except we have added a tank less water heater dedicated for the addition.
Please let me know if you have any questions.
Thank you for your help.
Thank you,
Caitlin
BCS BATIMENT LLC
Caitlin Sinkey-Kjemperud
Project Manager . 541-337-8306
specializing in project development
From: Branden Taggart [mailto:brandent@tigard-or.gov]
Sent:Tuesday,April 25, 2017 8:59 AM
To: 'Caitlin Kjemperud' <bcsbatiment@gmail.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Building Permit: MST2017-00033 -SUBS
Hi Caitlin,
2
I can add Evergreen gas to this permit. However, we will need you to complete a Request for Permit Action form as well
as a new mechanical permit application with Evergreen gas' information. Also,there will be a $45.00 fee for changing
contractors. This fee can be paid online once we make the change. I have included the link to the Request for Permit
Action form below:
http://www.tigard-or.gov/help me to/forms.php#revize document center rz279
If you have any questions, please let me know.
Thanks,
Branden Taggart
w City of Tigard
■ n. Permit Technician
Community Development
TIC ARO
13125 SW Hall Blvd
Tigard,OR 97223
(503)718-2449
brandent@tigard-or.gov
From: Caitlin Kjemperud [mailto:bcsbatiment@gmail.com]
Sent: Monday,April 24, 2017 12:07 PM
To: Branden Taggart<brandent@tigard-or.gov>
Subject: Re: Building Permit: MST2017-00033 -SUBS
Hi Branden,
We switched mechanical subs, here is their information:
Evergreen Gas
CCB: 158031
Please let us know if you need any additional information.
Thank you,
Caitlin
Sent from my iPhone
On Mar 30, 2017, at 11:28 AM, Branden Taggart<brandent@tigard-or.gov>wrote:
Thanks, Caitlin. I just issued the permit for Shannon to pick up.
<image001.jpg>
From: Caitlin Kjemperud [mailto:bcsbatiment@gmail.com]
Sent:Thursday, March 30, 2017 11:03 AM
To: Branden Taggart<brandent( tigard-or.gov>
3
Cc: 'Bruce Sinkey' <bsinkev@gmail.com>; 'Shannon Sinkey' <shannon.bcsbatiment@gmail.com>
Subject: RE: Building Permit: MST2017-00033 -SUBS
Hi Branden,
Please see attached electrical permit with supervisor electrician signature.
Thank you,
Caitlin
BCS BATIMENT LLC
Caitlin Sinkey-Kjemperud
Project Manager • 541-337-8306
specializing in project development
From: Branden Taggart [mailto:brandent@a>tigard-or.gov]
Sent: Wednesday, March 29, 2017 3:21 PM
To: 'Caitlin Kjemperud' <bcsbatiment@gmail.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Building Permit: MST2017-00033 -SUBS
Thanks, Caitlin. I will add the contractors to your permit shortly. You are welcome to send someone in
to pick up the permit.
<image001.jpg>
From: Caitlin Kjemperud [mailto:bcsbatiment@gmail.com]
Sent:Wednesday, March 29, 2017 3:18 PM
To: Branden Taggart<brandent@tigard-or.gov>
Subject: Building Permit: MST2017-00033 -SUBS
Hi Branden,
We have selected our Mechanical, Electrical and Plumbing subcontractors for permit MST2017-00033
13185 SW 115th Ave.
Mechanical:
Phillis Construction Co
DBA: Pyramid Heating and Cooling
CCB 59382
Electrical:
Tesla Electric Co.
CCB 189699
Electrical license C599
Supervisor 4697S
4
Plumbing:
H&H Mechanical, LLC
CCB 178122
Plumbing License PB414
Please let me know if you need any additional information for the permit. How soon would we be able
to pick up the permit?
Thank you,
Caitlin
BCS BATIMENT LLC
Caitlin Sinkey-Kjemperud
Project Manager ^ 541-337'8306
specializing in project development
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If
requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public
Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative
Ru|es ^CityGonera| RecordsRetentionSchedu|e."
<BraodeoTa&gart2.vu��
�.-
CITY OF TIGARD MASTER PERMIT
I 31: '' COMMUNITY DEVELOPMENT Permit#: MST2017-00033
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2017
F .p° Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Subdivision: None Lot: None
Project: BCS Batiment LLC
Project Description: 236 sq.ft. master suite addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 236 sf Basement: sf Left: 5 Parking Spaces:
Height: 24 Bathrooms: 1 Second: sf Garage: sf Front: 20 Smoke
Dwelling Units: 1 Third: sf Right: 5
Detectors. Yes
Total: 236 sf Value: $30,000.00 Rear: 12
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 236
Owner: Contractor:
BCS BATIMENT LLC BCS BATIMENT LLC Required Items and Reports(Conditions)
SKYTERA LLC 19705 SW 65TH AVE
19705 SW 65TH AVE TUALATIN,OR 97062
TUALATIN,OR 97062
PHONE: 541-337-8306 PHONE: 503-619-7070
FAX:
Total Fees: $1,611.02
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 AR 952-001-0090. You tarn a copy he rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: .:.V
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 project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential " FOR OFFICE USE ONLY
'yf Received
City of Tigard Date/By: / 23 . Permit No.: 1J7 )/7�
13125 SW Hall Blvd.,Ti azd,O J ,,.a ,t y /
Phone: 503.718.2439 Fax 503 9 60 s t Date/Bynew Other Permit: g'
'T I G A R D Inspection Line: 503.639.4175 �� y ft Date Ready/By / Juns: H See age 2 for
Internet www.tigard-or.gov + x r s\O '''` Notified/Method: , l>/17 j� Supplemental Information
���; � (4.,ret,,t,� Cote-t(,.-.�+1�
TYPE'OF Wv`� 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/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
.--CZ7d3-1-C) t
'14 1-and 2-family dwelling 0 Commercial/industrial �J
❑Accessory building ❑Multi-family Number of bedrooms: v ,I 0 3 0
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 19)\ ) sy\I \kG .7-\--4-e, , New dwelling area: 2.3‘,.„,/ square feet
City/State/ZIP: i c -
9 / or g-7 Zj 2- Garage/carport area: square feet
Suite/bldg./apt.no.: _J Project name: i 51.Y‘ 7 c;,d,'rh Or Covered porch Other structure area:
_ square feet
Cross street/directions to job site: Deck area: ,,T{l square feet
c 51/\I 1-�1"\'�er -- �j"��
a: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 9 V to NA i_-- Lot no.: /0/ Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 25 -1\(\i--0 �j w- . Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CN ,7 , }-D�ESSCRIPTION OFF�WORK work indicated on this application.
-J 1 1 iz,l i 1 c1dd'VI )U✓ I L{ 2-:�7�/ - " "�C Valuation: $
\ 11 n� Oil i •Fe ��yv��Li V l , a . Existing building area: square feet
kAtl xr3 ` ��Z V New building area: square feet
$PROPERTY OWNER 0 TENANT Number of stories:
Name: e(-1C-2- De v.1 C,pm-en"± Li--C' Type of construction:
Address: / GJ70,5- S1(4 (03-11/Vei. Occupancy groups:
City/State/ZIP: T a i etto Lz (375702_ Existing: h,..`
Phone: ) 93610 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: 33% rep(64 ' 0' (.-L (Please refer telex schedule)��_ ,_`� -iStructural plan review fee(or deposit):
Contact name: jll K
cos
FLS plan review fee(if applicable):
Address: f�/ 7pli
6,Q__
`� x Total fees due upon application:
City/State/ZIP: 1 1'� (�f� V��
- -- 3 l� � Amount received:
Phone: ); 7- )2)1511f2.
1/� Fax::( )
E-mail: Ci. L7y"'i e l /r M!z,(r„ Ltiyi, 1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
/ Commercial and residential prescriptive installation of
CON CTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: r Submit two(2)sets of roof plan with connection details
`%� COY- / / and fire department access,along with the 2010 Oregon
Address: /97£5 _ "j ( •we,, Solar Installation Specially Code checklist.
City/State/ZIP: Trial/' i' 97617 2 Permit Fee(includes plan review
$180.00
and administrative fees):
Phone:) i 1 )r` -- 4_ } / Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lis.: i9 i
it!lj el ' Total fee due upon application: $201.60
Authorized signatur;: k I ft i'-` - `"-' This permit application expires if a permit is not obtained
,.- ,,- within 180 days after it has been accepted as complete.
Print name:11r'l I � y' ( Date: *Fee methodology set by Tri-County Building Industry
Service Board.
ti/
I:\Building\Permits\BUP-RESPe itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
Mechanical Permit Application FOR OFFICE uSE ONLY
Received
�' City of Tigard Or'
ar,.V. VA •?. Date/By PermitNo.: ,' _ ,
-
13125 SW Hall Blvd.,Tigard,OR 97224---111,„„-'- � �. Plan Review
Phone: 503.718.2439 Fax: 503.598.1 .»" "` Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 ��tt L's (,., Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov \ i1 44 y Notified/Method: Supplemental Information
134
TYPE OF WORD` `GDy���1O4 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
1W... Mechanical permit fees*are based on the value of the work
0 New construction OAddition/alterati replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
;41-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
•(� d Air conditioning 46.75
Job site address: I f Q 6 9� 1 l' 1 .761Vei Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: IIga� L' -2. g 7'i� Furnace 100,000+BTU(ducts/vents) 54.91
• Heat pump 61.06
Suite/bldg./apt.no.: Project name: I I Gid ,+\a� Duct work j 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or i"y
- -vsn )( ( hydronic) 23.32 , c-.,
Unit heaters(fuel-type,not electric), ..
in-wall,in-duct,suspended,etc. 46.75 (ti
Flue/vent for any of above 23.32
Subdivision: ti . Lot no.: :OA 1+ Other: 23.32 F
Other fuel appliances:
Tax map/parcel no.: (ZC7—1_N 0' --501—N'. Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39 t
Flue vent for water heater orgas
`y ^� c. ( ,(? c-74- fireplace 23.32 1
����r�� i� ln��C ���� (' Log lighter(gas) 23.32
ChS 1 1 YV ("�liJ'
�,n Wood/pellet stove 33.39
Yi �� Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32 J„
PROPERTY'OWNER 0 TENET Environmental exhaust and ventilation: F,Name: /� U V ` ' 1 C- Range hood/other kitchen
�� equipment 33.39
Address: Aje Clothes dryer exhaust 33.39
i
City/State/ZIP: (14thI
n t C) 7 61,2— Single-duct exhaust(bathrooms,toilet compartments,utility rooms) N 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 P
APPLICANT ❑ CONTACT PERSON Other: 23.32
- ��
Business name: ` ') Fuel piping:
J l l $14.15 for first four;$4.03 for each additional
Contact name:aCtaitiO ).
! ' l\4 Furnace,etc. (�
Address: 7 ° • Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: V C
+ v4 !/� , C `- Water heater ter
Phone..4 ) 257— gioFax :( ) Fireplace
Range - -E
E-mail:' N\L ,T/ : Y ( C, \
Vecue
CONTRACTOR Clothes dryer(gas) v,
O i lei.G r 7f1e tOther:
Business name: y
/15, it S 615/ /64'41'144 'l�'stD"`f MECHANICAL PERMIT FEES*
Address: t l�a 9 A/. 1 r Subtotal
` / ,f Minimum permit fee($90.00)
City/State/ZIP: /�C,t,Ji-1w�I l x c 7
4 t Plan review(25%of permit fee)
Phone:( ) `7 _41-5---j).., Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 5ei
TOTAL PERMIT FEE
iJalp4....i, This permit application expires if a permit is not obtained within 180
� days after it has been accepted as complete.
:0::
si atura * Fee methodology set by Tri-County Building Industry Service Board
1 yin pri ,r p/ i te: 1•,r) i7
i\Buildin\Permits\MEC_PermitAPP_040113.doc` 440-4617T�11/02/COM/WEB
)
Docu _i n Envelo a ID:8B4E23-F0I.-I A-66E1-38AB5F131ACA
.._� . _.___� .�a.a.__�»....__ *. FOR OFFICI:tis1:O.Nl.l'
City of Tigard Received
DateB Permit 8:
• 13125 SW Hall Blvd.,Tigard,OR 97223 k, ; ',° !. Plan Review
s Phone: 503.718.2439 Fax: 503.598.196T. c L D, ./g : Related Permit ti:
Inspection Line: 503.639.4175 ;'> ely Date/By: Sums: Hl See Page 2 for
TICARD Internet: www.tigard-or.gov �' Notified/Method: Supplemental Information
TYPE OF WORK t p:x ' '. PLAN REVIEW
0 New construction Addition/alteration/repladerpent 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.
ID 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.
g1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ngs.
❑Multi-family ❑Master builder 0 Other: 0 amps for
all other installations. Inbustallation
pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: (� �S f\ e ❑Addition of new motor load of system.
100HP or more. ❑
City/State/ZIP: �� ❑Six or more residential units. occupancy.
i ' 0 Recreational vehicleparks.
❑Health-care facilities.j 0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: I�
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
..„Hi�' 'y—. Description I Qty. I Each I Total
ll\i X11 e4'� New residential single-or multi-family dwelling unit.
Subdivision: ' Lot#: t /V Includes attached garage.
> 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: -1- Ufs- -� Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
( yam_ 7 ' . �+ / y (with above sq.ft.) 75.00 2
I ti r• ' � 2 &(� `{ 1 boi Y 31 1 or Limited energy,multi-family
Q�. � �� / ��t 1`'t ( residential(with above sq.ft.) 75.00 2
PROPERTY OR (J f Renewable Energy ❑ See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name: J -n� _ ��Q ���jjj 9 1 200 amps or less 100.70 2
Address:1 61-7 ;iv 1 /\. 201 amps to 400 amps 133.56 2
,,,,:sl
y j 401 amps to 600 amps 200.34 2
City/State/ZIP: a /� J 6i)2.• 0`-7i, 601 amps to 1,000 amps 301.04 2
Phone:(F14-1)' 7.- l // Fax:( ) Over 1,000 amps or volts 552.26 2
„,� '\ Temporary services or feeders installation,alteration,and/or
Email: nLrJ-7 7 relocation
Owner installation:This installation is bein ade 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-cci new,alteration,or extension,per panel
't/�• A.aboverervichrfeedswet,
Business name: fl/ ,, above service or feeder fee,
7.42 2
ji� each branch circuit
Contact name: 61 r .. .e_ ,' B.Fee for branch circuits without
Les-1r\ branch circuit service or feeder fee,first
Address: �� C'' 56.18 2
`
City/State/ZIP: "' nct � 1�` `/°l r )71:1412-• Each add't branch circuit 7.42 2
1 `r 7� t Miscellaneous(service or feeder not included)
Phone: ) ;212-5 ,-!' Fax::( ) Eachmanufactured or modular
,d fd
67.84 2
�?� � dwelling,service and/or feeder
Email: 0Z w ( Reconnect only 67.84 2
CONT OR Pump or irrigation circle 67.84 2
Business name: '--T- Tesla Electric Company Sign or outline lighting 67.84 2
Address: 2850 Cedar Hi.] s BLVD #250 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Beaverton, OR 97005 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 503-705-2285 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: tesl apdx@gmai 1 .com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 189699 Electripallulce,isGAPA,: Suprv.Lic.: 4697s specifically listed(Vs hr min)
/��'I� I'l/�, ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require J:W1lA.iGUA1 WU.IVY'ii Subtotal:
Print name: Wi 11 i am W Whi r r\i—E65aA7DB665c34s1... Date: 3/30/2017 0 Plan Review Required(25%of permit fee):
�a State surcharge(12%of permit fee):
Authorized signature: a '' jo TOTAL PERMIT FEE:
rr-7-,„----: This permit application expires if a permit is not obtained within 180
Print name:� /N i'//Lt`1( r Date: (i )7 days after it has been accepted as complete.
{' i v * Number of inspections allowed per permit.
I:tBuilding\PermitslELC_PermitApp_ELR_ERE.doc\s,06/17/201 440-4615TO 1/0/COM/WEB
Plumbing Permit Application
Building Fixtures , FOR OFFICE USE ONLY
City of TigardReceived
Date/By:
Permit No.:
r ' ,
U 13125 SW Hall Blvd.,Tigard,(c)&223' I
? 1 Plan
1 Phone: 503.718.2439 Fax: 503.598. 9Date/By:
_
Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
IIGARI) 1k , 1 Y Y B
Internet: www.tigard-or.gov f 'kT It"----jt��'tr1{ Notified/Method. Supplemental Information
w� ®' FEE* SCHEDULE
•
TYPE OF WAN�❑New construction molition For special information use checklist
Description QIY. I Ea.
Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Y"A 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
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: I iJ i"Ar f Catch basin or area drain 18.76
mor-7-2,2, Drywell,leach line,or trench drain 18.76 a.�
City/State/ZIP:
/ Footing drain(no.linear ft.: ) Page 2 `4i.'
Suite/bldg./apt.no.: ''' Project name: 1 1r--511‘ Manufactured home utilities 50.03
Cross streett//directiionns/ tt�o�jjobb site: Manholes 18.76
C.re.��/ V 1'b 1 2 1it � Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2 r-
Water service(no.linear ft.: ) Page 2 n
Subdivision: I f(\V � Lot no.: i i D Fixture or item:
Tax map/parcel no.: •-�Y V- 1 J V V---NI'� Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
���/1 /e17,p", , i' .<C11417--5(7 Zl_-e4- --Jr-44"a-J tinn1'f, , Clothes washer 25.02
1 { iV i; ll7(V �S 1. f Dishwasher 25.02
�mDrinking fountain 25.02
77.; Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: v �O u� Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1( �0� //�� � � j Garbage disposal 25.02
City/State/ZIP:-11/1` (� het' `v n ��� J 7�
r Hose bib 25.02
Phone:� , ) � / Fax:( ) Ice maker 12.51 _
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 si
Business name: f r/)' 4 q9Y CIG Medical gas(value:$ ) Page 2
x ���ttt///���V° Primer 12.51
Contact name: -�-� /lamdely- iv/ (/6'eRoof drain(commercial) --{'� 12.51
Address:i �7OE < 'YC , Sink/basin/lavatory t, )) 25.02
City/State/ZIPTTUSt l s 9761672-- Solar units(potable water) 62.54
Phone:1 ) '7-f l rFax::(,, ) Tub/shower/shower pan 12.51
E-mail: tOGS j j' !'i I((1 t:t: L° 1( G', t r irief \ Urinal 25.02
J Yt.1,j� t Water closet , 25.02
CONTRAC R'
Water heater 37.52
Business name: H �� /c r Vf /1 Water piping/DWV 56.29
Address: " "7 S ' i3 IA).//(; ^� Other: 25.02
�{' r/�: '4,44 it I� l et / 1 ,2 Subtotal
City/State/ZIP: �- / VV"°° v'`-cr✓
Phone:(jc 3) C(75._fl 7i`7 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: / 737 Plumbing Lic.no.: '`��y Plan review (25%of permit fee)
' _ _ 1 State surcharge(12%of permit fee)
Authorized signat .• ��/�'.1�W!'-- TOTAL PERMIT FEE
Print name: C4/. W1'--
�� Date: i/z5/ 1 This permit application expires if a permit is not obtained within 180 days
"t / after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
City of Tigard
qIli COMMUNITY DEVELOPMENT DEPARTMENT
I
l c A a o Building Permit Review — Residential
Building Permit #: 71-2s7-a,,,17•—c) X),33
Site Address: `j 14 5 kf\j \`cj-fy\ AN-'
Project Name: 1l Th Ave. MdM Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Sf a. ,im,fly
*Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Si$e Plan Elements:
Three(3)copies of site plan xisting structures on site
)Z(Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
ADrawn to scale(standard architect or engineer scale) floor elevations
Torth arrow Utility locations(required for new,may apply for additions)
,ite address,project or subdivision name and lot number Nf ,ocation of wells/septic systems
lipplicant information(name and phone number) existing trees to be retained with drip line,and tree
of dimensions and building setback dimensions rotection measures
Lot area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) A treet names
Nj Property corner elevations (2 foot contour lines if more than
� foot differential)
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: (Yes,applicant was notified ❑ No Received: ❑ Yes cNo
Public Facilities Improvement (PFI) Permit
Required: ❑ Yes,applicant was notified a No Applied For: ❑ Yes ❑ No,stop intake
El Land Use Case#: L 201(0—(c1(0
5' Zoning: 12 1..4.;-
Required Setbacks: Front 2.0 Rear /Q Side 5" Street Side 0/Garage 20
Landscape Requirement: f\//A % (-4>A1>T30 to 00 i'-7
elE Lot Coverage Maximum: N/A- %
X, Building Height: Maximum Height r
(1 Actual Height
Visual Clearance 01A-
•
Easements
Sensitive Lands: ❑ Yes No Type
NR-Urban Forestry Plan
1\J f Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: -=� ; Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw REs 091216.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: # 3
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: anningEngineering ermit Coordinator iii ding
Workflow Sign-off: U-431-in-off for Planning(include notes from planning review)
Route Application Documents: gineering: (1) copy of permit application, (1) site plan, (1) building plan and
o al plan review routing form.
E'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: /4--/7
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: & J Date: f-_,j4--/7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved 0 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 Tax: ❑ Yes jErN/A
Tigard Trans SDC: ❑ Yes /WN/A
Parks SDC: ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_RES 091216.docx
Branden Taggart
From: Erik Peterson <erik.nwarchitectural@gmail.com>
Sent: Wednesday,January 25, 2017 10:41 AM
To: Caitlin Kjemperud; Branden Taggart
Subject: Re: FW: 13185 SW 115th Ave.Addition: MST2017-00033
Hi Branden,
Appreciate the heads up, since this is basically a remodel, we are not adding much but merely replacing the
existing fixtures, etc.
In the "new" master suite, we are replacing an existing shower with a separate spa tub and standalone shower
and replacing one sink with two.
So, with regard to the plumbing fixtures, we are adding one tub and one lay.
Regarding the mechanical, per our subcontractor, the existing system can more than handle the 236 sq.ft.
addition, so we don't need to add anything new to the AC unit other than one duct and a new exhaust fan for the
water closet.
And regarding the electrical system, we will have to add (2) branch circuits to the existing panel to cover the
'addition'.
Please call any time if you see any issues: 503-476-5486.
Thanks again, Erik
On Wed, Jan 25, 2017 at 9:52 AM, Caitlin Kjemperud <bcsbatiment@gmail.com> wrote:
See below
BCS BATIMENT LLC
Caitlin Sinkey-Kjemperud
Project Manager • 541-337-8306
specializing in project development
From: Branden Taggart [mailto:brandent(a,tigard-or.gov]
Sent: Wednesday, January 25, 2017 8:57 AM
To: 'bcsbatiment@gmail.com' <bcsbatiment@gmail.com>
Cc: #Building Permit Technicians <TigardBuildingPermits(aitigard-or.gov>
Subject: 13185 SW 115th Ave. Addition: MST2017-00033
Hello Caitlin,
1
We received your permit submittal for the addition located at 13185 SW 115th Avenue. However, the
applications you provided did not have the number of appliances, circuits, or plumbing fixtures listed under the
fee schedule section of each application. We will need this information to calculate the fees for plan
review. You are welcome to email the completed applications to me. Once we receive the applications, we
will begin plan review. If you have any questions, please let me know.
Thanks,
Standen Taggart
City of Tigard
a Permit Technician
Community Development
T WARD
13125 SW Hall 81Vd
Tigard, OR 97223
(503)7184449
brandent tigardMor.gov
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-
mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are
retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention
Schedule."
2
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
1oi
111 11 Transmittal Letter
1 c,n R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ` DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
Y--)\ -e--ft._) MAY 1 b2017
FROM: 11V � •
��� CITY OF 1'IOARD
COMPANY: ,\k/ 1/4-\r C ,,k,, U
► �3UILDING DMSION
�j
PHONE: t3 C D 0� ( By:,
RE: ' - NJW CQ 7 A<W w :2 ti Gle03 c- •
ite . •:re (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: D ription:
Additional set(s)of plans. 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):
REMARKS: . Q tr(r1 '`e l -,t-e \_--c---,
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: 4-- ) C- ) -'l Initials: 4.)
Fees Due: pg Yes ❑No Fee Description: Amount Due:
;� >�r- pi r e...G.A../ $ 1-K- -
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yes No Done
Applicant Notified: Date: .<-/i c'' 1> ( nitials: 11
pp `�-
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
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 Letter
to
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-o .gov
TO: DATE REC 1VED:
DEPT: IBUILDING DIVISION ECEIVED
E®
FROM: VIZ k
JUL 1 9 2017
^� .'<ismer w • �► ,,►fir t° ,
COMPAN . fiit�r� �- (iLti[ , •
PHONE: * ' � — • k By:
RE: • ( Gj 0).( (SCS
C "
ite a cress (Permit Numb
(Project name or subdivision name.,d lot n a er)
ATTACHED ARE THE FOLLOW I G. 'MS:
Copies: Description: Copies: Description:
Additional set(s) of pl.atRevisions: cf-eloG4ofdt
Cross section(s) and de!?1 . Wall bracing and/or lateral analysis.
Floor/roof fr. ' g. Basement and retaining walls.
Beam calcul ions. Engineer's calculations.
Other(exp ain :
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: 7 -Zo .- )`7 Initials: �)
Fees DueJYes ❑ No Fee Description: Amount Due:
1 1-� $- nom----
�9
/ e - his !' ,,7 /gel' $
Sys r7 ,J2 a C3 7h-7 $
e4,vnle $
Special
Instructions:
Reprint Permit(per PE): ❑ Yes Pa No ❑ Done
Applicant Notified: Date: 7/aZ yl - Initials:
SfioHe )/72, rc/��
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1111 II
Request for Permit Action
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223,,•,503-718-2439,,•www.tigard-or.gov
i4.,„1,;(jVS V
TO: CITY OF TIGARD
Building Division i.{ 4 2_017
13125 SW Hall Blvd.,Tigard, OR 97223 1/4„..j Cy , .t
Phone: 503-718-2439 Fax: 503-5984961 Tiga11ermits@tigard-or.gov
FROM: n Owner ❑ Applicant n Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: BCS BATIMENT LLC
INVOICE TO: (Business or Individual)
Mailing Address: 19705 SW 65TH AVE
City/State/Zip: TUALATIN OR 97062
Phone No.: 541 -337-830
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
I I REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
E INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
n REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST 2017-00033
Site Address or Parcel#: 13185 115TH
Project Name: 115TH
Subdivision Name: Lot#:
EXPLANATION: ELECTRICAL CONTRACTER COULD NOT
MEET OUR SCHED E
Signature: Si kAi• 10-3-17
Date:Print Name: ,' MPERUD
IP
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
DocuSign Envelope ID:A4843611-D3DC-400D-A32B-6D3A8DD04F29
Electrical Permit Application , k* FOR OFFICE USE ONLY
Received
City of Tigard •�a i.9-,, DateB : 0 in IN a pi..
13125 SW Hall Blvd.,Tigard,OR 97223 l d7 Plan Review
Phone: 503.718.2439 Fax: 503.598.1901 . t. :I Date/B Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Janis: H See Page 2 for
Internet: www.tigard-or.gov Notified Method: Supplemental Information
h11"4'
ilk j,' ;I„ Y1' Pr ` .......� JA 1lrIg l
IrR❑New1-5k construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked).
❑Service or feeder 400 amps or more ❑Building over three stories.
E Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
:it °Illi'I 7 AT * R ! r I T TRI)„ ION' �° - !'9,r '” -- exceeds 10,000 amps at 150 volts or 0 Floatingbuildings.
�ri g
® 1-and 2-family dwelling ❑Commercial/industri•. vii ', 'SQ Itit.ing less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
it� 0 Fire pump.CI Multi family ❑Master builder L 'li ❑Emergency system. El Installation of 150 KVA or
- ' _ 1�n. lk 'JOSSIT NF*W A ''ON A '.IryO'''''''::1-16--: "'AA- lt
larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address:13185 SW 115TH AVE 100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:TIGARD OR 97223
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 115TH ADDITION ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site:SW FONNER ST 11th .1i CIIJE pig , Nll t.
oR - i - mss
DescriptionI Qty. 1 Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:WDML I Lot#: 110 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S-1W-03-SW-NE
�„ „ Ea.add'l 500 sq.ft.or portion 33.92 1
Ilk �I� .... �` .,l�i"^, �, ,pES ,IPI�'q, l"1' �UR t1llii�i ����C�(i inti I_
t�H„ . A'''''"' - Limited energy,residential 75.00 2
SMALL ADDITION OF 236 SQ FT AND REMODEL OF EXISTING HOUSE (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Yt.- - „ ,_y Renewable Energy 0 See Page 2
��0`P32�IPE Y O ER �� " jam"` ,:,!❑F' NAN'-F "i _ Services or feeders installation,alteration,and/or relocation
Name:BCS DEVELOPMENT LLC 200 amps or less 100.70 2
Address: 19705 SW 65TH AVE 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:TUALATIN OR 97062 601 amps to 1,000 amps 301.04 2
Phone:(541)337-8306 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
5o 9 ;�ii �9 ii m �t Branch circuits-new,alteration,or extension, er anel
Alt A.Fee for branch circuits with
Business name:BCS BATIMENT LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name:CAITLIN KJEMPERUD B.Fee for branch circuits without
Address: 19705 SW 65TH AVE service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:TUALATIN,OR 97062 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(541)337-8306 Fax: :( ) Each manufactured or modular 67.84 2
Email:BCSBATIMENT@GMAIL COM
dwelling,service and or feeder
: �
Reconnectonl
Y 67.84 2
P� . m . ' aCO RA "OR ma :- ���
Pump or irrigation circle 67.84 2
Business name:ERIC OLSON ELECTRIC INC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 10013 HAZEL DELL AVE.PMB 432 panel,alteration,or extension.
City/State/ZIP:VANCOUVER,WA 98685 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)609-4901 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:ERICOLSONELECTRIC@GMAIL.COM Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 179408 Electrical Ljc_ouoig y: Suprv.Lic.: 4910S specifically listed(%2 hr mm
f 8 v.a. tCT'II, P ` t1 „raw,
_.I t� n
6 L
Suprv.Electrician signature,required: EVIG SObt. Subtotal:
Print name: E r1 C 01 son —4DD6C522D14D473.I.Date: 10/4/2017 ❑Plan Review Required(25%of permit fee):
—DocuSIgned by: State surcharge(12%of permit fee):
Authorized signature: Caigil,A, ..itAirt,VIAI TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: CAITLN-KJE4WIIMehlasoAS APPLICANT Date: 10-3-17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(t l/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 6, 2017 at
9:31 :43 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 6, 2017 at
9:44:51 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved plumbing, electrical and backflow devise final inspections.
Provide approved final erosion control inspection.
Note: non conforming step from lower level door to exterior stairs existing.
Non conforming Egress windows existing.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 6, 2017 at
9:20:04 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Kitchen and master bath outlets gfci breaker in panel not resetting.
All else appears ok per permitted branch circuits.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 6, 2017 at
9:35:50 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Add lower level sink and ice maker to permit.
Rough in done, no sink installed at this time.
All else appears ok.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 15, 2017 at
10:51 :09 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 15, 2017 at
10:55:01 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Correction complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 12, 2018 at
7:34:18 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00033
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
This inspection to correct previous inspection dated 12/15/17 passed with C of O.
Final inspection approved, no C of 0 issued.
C of O's are not re issued for existing house re-models as the existing structure would
have been issued a C of 0 prior to occupancy.
Violation Summary:
Inspector Contractor