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Permit Support Document (24) ,.1.1uildin Perinit A lication kil , 1 ...„ '.... , It P0:04.07#1 /// / FOR OFF/CT,' LSE ONL V City of Tigard fmetcee/Bived. - Apr _ permit No.. ''..... . owe . 4.7 _ fl 13125 SW Hall Blvd.,Tigard OR 97223. * ' Plan Review ii Phone: 503.718.2439 Fax: 503.5981960 , Date/B : Other Permit:,44 a? t ;II' Inspection Line. 503.639 4175 ' ' TIGARD ' )111 Date Ready By: rivii El See Page 2 for Internet: WWw.tigard-or. Not ruction ffs Supplernental Information .._...ir . Ntii4*,T*,,,tptok',4r, ..14,,,,VIvr.- --,,,,:::‘e-..4','',(11, ,z.0--0, -,ii:,,,,,t4,44:44*,4, 0,1401--,,..41i4,0 ,,,,,,,,,, t.,,,,,,_ ,, ,•,, ,,,,,, ,..„,,,,,„,,,,,,,,,,,,,,,,. ,,, ,,,,..., t, .,,,kit„',',g,44, w,tesk5.,..44,.: 0 New construction 0 bernolitiOd' : ' - Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all fa Addition/a/teration/replacement 0 kifhdr: equipment,materials,labor,overhead,and the profit for the t:;&.ieo''W:'dkt;Ab.V' -yk4f,,z'Ax'Lo '.';'-i*,1:',a'Z*,K,„.VOXif,e'titL;41 work indicated on this application, crix-ry,41;txt,*,:akillq% ,,v,,A,t,,,,t,-, 4-7ti*Ortw ' Valuation: $6,000.00 0 1-and 2-family dwelling 0 Commercial/industrial Number of bedrooms: 2 0 Accessory building 0 Multi-family 0 Master builder 0 Other: Number of bathrooms: 1 ilnavitivtA40:)::t.:44tomfo-30::**ktellailltgi Total number of floors: 1 Job site address:11631 SVV 114th Place New dwelling area: 114 square feet City/State/Z1P:Tigard,OR 97223 Garage/ea/port area: square feet Suite/bldg./apt.no.: Project name:Ra throom/Closet Addition Covered porch area: square feet Cross street/directions to job site:Tigard St.&SW 114th PI Deck area: square feet Other structure area: square feet 4.7.CIN:64:44.40Z117;;!,;::4::: :::7:1,40:4274III Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equkipmdeot,tmdateriatls,laboir,ov.erhead,and the profit for the A43111.41:-.'.4-;714417-'.11...6',L'.131*.',..,,,,,,,',*Pg491c.lir.M.Witlr414:-.. .4.1171csleiU7;!--Nt..:134$ vvor In Ica e on Ms a..icatIon. 6'x19'Rathrooni/C/oset Addition Valuation: $ Existing building area: New building area: square feet City/State/ TigaOR 97223 r°f st°11es: square feet Phone:(503)523-8222 1,rtiliritirtit;'..nr,'qit ,:i.--.*'•-1-art*--„'"...grtft.N.,-Nki.1.0..t,:.....,4-.',Th.E*-,,--1,1.74,:wo .„, .';14ii-''Aiat.a.-464:4ti.t.4k:,m:t:!',C-'*i&ttW'At'Atfire;;AkVtitttf%::kk!tii Numbe Type of construction: Address:11631 SW 114th Place Occupancy groups: ZLP: rd, 1111114111,Catffilg454114M,VNOLVar:e:it:,r,f4:1:Afilrn girz:VIPL.,,qiii: ' .1 -tin%':, t- i- ' .' - ---itt: ,-1-24,,,----.. Structural plan review fee(or deposit): Contact name:Same as Above FLS plan review fee(if applicable): Address: Total fees due upon application: t , laf Amount received: Phone:( ) lettrati:-::rAl. 41%;. 0''414,44114 1 Alit COinn;rcia/and residentiarjZriptive installation of SalttaTafttrt,aM. .-fAA:'-....;.r.:;,P--:,!ftt..:;!rlc:4.tzNk-AAttktkiltt roof-top mounted PhotoVoltaic Solar Pane/System. Submit two(2)sets ofroofplan with connection details and fired epartment access,along with the 2010 Oregon Address: Solar Installation Siecialo,Code checklist. city/state/zw: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) , State surcharge(12%of permit fee): $21.60 Total fee due upon application: $201.60 Authorized signature: , ,---7------ 3 la/g 5.,1, This permit application expires if a permit is not obtained 1 within 180 days after it has been accepted as complete. IIINAirs- .sFeerve,zeet8hoodarodlogy set by Tri-County Building Industry Date: 6,. ,i-r alip:all 1:IBuildinglPermitsIBUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) .+ i FOR pFE10E USE ONO(ligation CheC1�1St' Permit No.: Permit A lice geceived Buildin per Dwelling DatelBy: Mechanical One' and Two _Family Associated permits: plumbing � Electrical No NIA 111411 of Tigard ata OR 91223 other: Yes ❑ City Hall Blvd.,Lille: 503.598.1960 ❑ la 13125: 5 2439 Fax: REVIEW ❑ ❑ ❑ _ Phone. 503.118. 503.639.4115FOR PLAN IZ ❑ ❑ E Hour Inspection a oT gov REQUIRED ❑ ❑ TIG ARD Internet: www.tig ARE ❑ ❑ s etc. ❑ ❑ ❑ criteria for concurrenthiston district, ❑ THE FOLLOWING ITE�unsdre seismic oils desi.nation, ❑ ❑ coons completed• See .pints, 0 ❑ 0 1 land use actions solar balance 0 0 Land . Flood ,tired.• e of district: .achy_-- ❑ ❑ 0 2 roved remodel. Existin.system ca ❑ 3 Verification°f�a rove]re mired. Nam for rem ❑ 4 Fire district a It or authorization d location of catch 0 erm file or with a .licnce 0 5 Se tie system silt fence design an 0 . and si nature on Sewer ermit. e way protection> d state 6 , rove]. final a•.licable Stam drainage-way applicable local an 11 size 1 Water district a ori: required. Include urate fu ort. Must ca it req conformance top or on a separate feted if 8 Soils re fan 0 permit ew to scale,showing into the plans cannot be comp 0 0 control ❑p orated plan review 0 9 Erosion etc. lens. Must cbeo drawn must be incorporated basin ,rotection, of legible p connections rn len location and property comer elevations(if 10 Complete sets n details and between p of easements Lateral design references dimensions;pTOp location codes. fans with cross refer setback ft ions;p op direction building to the p lot and building lines at 2 utility locations; sheet attached exist. The plan must show show contour stems; aures on site;and 0 0 ht violations len must wells/septic systems; stru 0 co�and d= len drawn to scale. differential,p location of w area, 5itelplot p elevation decks); e impervious details,vent size 0 11 ore than a 4-ft. to(including e of coverage; connection 0 0 percentage ads,conn there ism footprint of structure coverage area;p reinforcing p driveway; building dimensions, s and water heater, 0 0 lot area; hold-downs detectors, 0 indicator; anchor bolts,any of smoke surface draina_e dimensions, window size,location ade,etc. joists,sub fan. Show inches above'. s headers, 12 Foundation p identification,d decks 30 such as floor beam a room uired to clearly portray footings and location. all dimensions,fixtures,balconies and sizes and spacing be req material, 0 0 tans. Show .lumbin- height siding 0 13 Floor p fans, all framtng_memcross section may ceiling furnace,all construction, and details. Show More than one roof slope remodels.construction. sheathing,roofing, Cross section(s) coon,roof roof sh etc. envelope' 0 0 14 or,wall constru all wall and al insulation, °f two elevations °rfo drat buildtngns atid e 0 flO Shoot details of construction,therm construction;minimum eater than coon. fire lace constru e in grade is gr acc stable. for non- 0 construction. stairs, for new change references are locations; ❑ 0 and foundation, Provide elevations grade if the cross refer details and views' reflect the actual ion elevations with ns Must enceatestandards. and bearing 0 15 Elevation must tiv foundation analysis p iindica_ spacing, 0 0 Exterior elevations s showin lateral aridly enC member sizing, p Full-size sheet addendum path)and/or and calculations to entineer 0 Full resg. Ptive blies, For engineered 0 Wall bracing(prescriptive .rovide s�ecifications ent of rebar. 0 16 .ath anal fans for all floors/roof assemblies, placement joists.Base ent provide p d details showing p and multiple j ❑ 11 ,nescnFloorlroof framing. ventilation.Provide cross sections an design values for all beams 0 0 0 locations. Walls. Pro current code 0 Basement and retainingntineer's calculations." alculations. using carr load. required ❑ 18 Basem 22 " a nonuniform schematic is req ❑ s see item Provide two sets of calculations Agas-piping ❑ s stems, beam]otst caot 19 Beam Energy Code calculations. an n details. provide calculations• ed by tanic engineer d 10 feet fon: truss desi. tive path or p stamp over floorlroof the prescriptive roof truss)shall be 0 Manufactured compliance. Identify shear wall' der review. 0 ❑ 20 Code comp provided,(i.e., .ro ect un ❑ 0 21 Energy ,.liances• required or pro t be a•�licable to the 0 0 more a when req x l�" ❑ for four or and shall be shown x ll"or 11" ❑ 0 22 Engineer's calculations. EC IFICS s must be 8 112" ❑ ❑ architect licensed in Ore_°L SP ,ted. ❑ RISDICT ION A for Item 1 l above. Site a above. will not be acc' ent. ❑ ❑ JURISDICTIONAL U resulted 19 20 and .tans tpees docum � ❑ .fans are re "Mirrored"buildin_ Develo amen Three n site wired for Items 16, ,e-ons, Permit&System and City of'Tigard 0 23 are re er to in the P 0 an eacha outlined >f applicable), 0 24 Two(2)sets , shall not contain red lines r ( driplines, Buildin_ glans .fans must meeten:ippr scaleroject street tree plan0 25 $ed'buildm_ standard architect or per approved p rove]. Tree locations, 0 0 26 Bever indicates sten type and location of approval. of a''rove]. 2� Drawn to scalerequired by conditions si: additions, s include tree size, .ro ect arborist's ening Site plan to ares as required for all building 28 fist. and tree protection meas must include the form is req existing residential. Street Tree 1 trees drawn to scale and m Site Assessor aures to 29 Site plan g includemust bePre-Screening and accessory structures d .rotection measures sensitive Area non-impervious surface) A Clean Water Services' e Ces Sen (over non-im ber 9,1995. B) decks,patio to S-.tem including 'riot 44p-4613T(111021COM n a lot of record a •roved .nrtits�UP"RESPernv�Pp�aoc 0212412011 Mechanical Permit Application FOR OFFICE LSE O\LI Cityirl of Tigardit �"oc) Received /� Permit No.: ')) r g N Date/By: W �✓ 1� i 1J ,' r 1 13125 SW Hall Blvd.,Tigard,OR 97223 t- a r i Plan Review Phone: 503.718.2439 Fax: 503.598.1960 'RV..0 �� Y. Other Permit: Date/B TIG A R D Inspection Line: 503.639.4175 r,,, " �0 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov a, '� a`glifie /Method: Supplemental Information )� CLi ' CIN-' TYPE OF WORK O COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ,-i t';,, Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alteration/replae ``' performed.Indicate the value(rounded to the nearest dollar)of all,� mechanical materials,equipment,labor,overhead,and profit. El Demolition ❑Other: _ �1 P Value:$ CATEGORY OF CONSTIWCTION RESIDENTIAL EQUIPMENT i SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: C u + Air conditioning 46.75 Job site address: ii,-.3\ c7 1 1) 1 ,,«....., Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 74-6,-.), 11-213 Furnace 100,000+BTU(ducts/vents) 54.91 61.06 Heat pump Suite/bldg./apt.no.: Project name: \rkk\ Duct work Z 23.32 IBJ,(yy Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 -• DESCRIP'T'ION OF WORK 4"m`` Gas fireplace/insert 33.39 '1]'� Flue vent for water heater or gas E - J')t cs -car- doj fireplace 23.32 Or y Cat,dc -� vJW1 _ t- �i _bp M Log lighter(gas) 23.32 (T` Wood/pellet stove 33.39 Ill - JIGk / �l/14-0`Bk Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 Or PROPERTY OWNER ❑ TE+l 1 ' w: Environmental exhaust and ventilation: Name: 5 t f f(. 'P^,`\ Range hood/other kitchen equipment 33.39 Address: $i yCc'_ et aijO Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, l toilet compartments,utility rooms) ( 23.32 2-3.:3;)`• Phone:(SG'S ) Sr) - $uL Fax:( ) Attic/crawlspace fans 23.32 1:1r API' ICANT 0 CONT .' ' AOther:PERSON 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: _Furnace,etc. Address: Gas heat pump _Wall/suspended/unit heater _ City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Wt S e5N1/4.0. CO y,,.` Barbecue .. . CONTRACTOR Clothes dryer(gas) Other: Business name: y‘4...c..- MECHANICAL PERMIT FEES* Address: Subtotal (.411 c City/State/ZIP: Minimum permit fee($90.00) �y -610 Plan review(25%of permit fee) V Phone:( ) Fax:( ) State surcharge(12%of permit fee) i 0.. ifiv CCB lic.: TOTAL PERMIT FEE/ tea,. ip This permit application expires if a permit is not obtained within"AO 0 days after it has been accepted as complete. Authorized signature: _ $ Fee methodology set by Tri-County Building Industry Service Board Print name: "3-oLe___ \)a`\ Date: EFir I:\Building\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard f 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. kI:\Building\Permits\MEC_PermitApp_040113.doc 2 1 Electrical Permit Application ,,: A'' . FOR orr-lcr isl: o\l.l • City of Tigard <*Y• 14 '''%\`', Received gate/B : •r • 13125 SW Hall Blvd.,Tigard,OR 97123' \ �' v ```. .,",n Review ' ! Phone: 503.718.2439 Fax: 503.598.1960i, , „:1•°,,C::,\, Date/B : Related Permit#: Inspection Line: 503.639.4175 3l°�,,,, Ready Date/By: kris: ® See Page 2 for T I GA R D Internet: www.tigard-or.gov ( S A`> Notified Method: .:;\::, v��,4. Supplemental Information TYPE OF WORKOP"' PLAN REVIEW ❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building 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. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 6 ❑Addition of new motor load of system. Job#: Job site address: 1\631 31 $ ,j 6 l y ri 100HP or more. ❑°A",°°E",°l-2", °1-3", City/State/ZIP: 70 ©IL q ZZ 3 0 Six or more residential units. occupancy. 5/14 �J+ ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: V A.1\ ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 / DESCRIPTION OFt//WORK Limited energy,residential i/EBF S t /L 1/G 4 L�O.�t)— Ll p (with above sq.ft.) 75.00 2 L / l Limited energy,multi-family 1/q- V0.d11+ )i'fq— '� residential(with above sq.ft.) 75.00 2 J Renewable Energy 0 See Page 2 0 PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: CR,55.t_ Y'%\1 200 amps or less 100.70 2 Address: 5401-1.-. etS 4o,/te , 201 amps to 400 amps 133.56 2 •C/ 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:(5,3 ) 5Z3-T.,Z.2Z Fax:( ) Over 1,000 amps or volts 552.26 2 Email: r` //��yy Temporary services or feeders installation,alteration,and/or WA s M'`\\.L.-71t'\ 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, d 7 201 amps to 400 amps 125.08 2 Owner signature: '4------------_ Date: Z 10 401 amps to 599 amps 168.54 2 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit Z. 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) hr min Investigation(1 g ) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed(1/2 hr min) 90.00/hr 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): ��� TOTAL PERMIT FEE: Authorized signature: rC� 1/c�9�` This permit application expires if a permit is not obtained within 180 Print name: �'e7tl( Date: 3-'111, I days after it has been accepted as complete. 1 * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB 7 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each Total * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: In 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 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 in Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n 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(1/2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES 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 n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PerrnnApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application Building Fixtures t ,� �. FOR OFFICE ESE OV�I.l City of Tigard , - �'` ", Received IIIIIU 13125 SW Hall Blvd.,Tigard,OR 9160t„,,„.•,-# Date/By: Permit No.: r"17-/�U J� ClO ,cam/ ■ U Plan Review ©x ` r717 6 Phone: 503.718.2439 Fax: 503.598. � Inspection Line: 503.639.4175 ���� `' Date/By: Other Permit No.: TIGARD b,--14�Read/B Internet: www.tigard-or.gov ' , ,.Ready/By: kris: Supplemental See Page 2 for 6 ldottfied/Method: Supplemental Information TYPE OF.WORK 0` s FEE* SCHEDULE ❑New construction 0 Detri> For special information use checklist , ElAddition/alteration/replacement 0 Other: Description Qty. Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY Of CONSTRUCTION SFR(l)bath I I 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 1=1Accessory building 0 Multi-family SFR(3)bath 500.32 El Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 Site utilities: SITE INFORMATION AND LOCATION � Job site address: 1101 s tii I) Y'l _ Catch basin or area drain 18.76 City/State/ZIP: -1-46ertk 0 `i 7773 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:35 ) i Page 2 Suite/bldg./apt.no.: I Project name: V1/44.1l Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 - v a Backwater valve 12.51 p Clothes washer EA, ,New ,k0\14-- 25.02 / Dishwasher 25.02 IYEA-E NA��''t`�. Ik©We� Drinking fountain 25.02 J' S 1'^IC_ Ejectors/sump f 25.02 1 �C O'rrioti ;' YjUV1 R ,,, ,ok t.., ., ;.^�. Cl N v ,�,-:.. Expansion tank . 12.51 Name: "- u \ Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 S .� a3 a\- b o v,Ci Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:(,o I,) 523 -1:3 22'1- Fax:( ) Ice maker ° � 12.51 -CJ A"I*PLIC N "` ,_ £1 cONTTAc t EERso 1I , Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 ..5 ctherl Primer 12.51 Contact name: Address: Roof drain(commercial) 12.51 Sink/basin/lavatory ' 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan i 12.51 E-mail: is j W tt y co m,.., Urinal ! 25.02 CO VTRACTOIt Water closet 1 25.02 4 Water heater 37.52 Business name: dj, � Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: Authorized signature �� State surcharge(12%of permit fee) ( TOTAL PERMIT FEE Print name: I T iv?. 1l1_ IThis permit application expires if a permit is not obtained within 180 days '�G,$,�z- ���� Date: C7 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard R . Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site tJtitit es Qtr•' Fee(ea) Total' Square Footage: Permit Fee: Footing drain-lst 100' 50.03 0 to 2,000 $121.90 37.52 2,001 to 3,600 $169.69 Footing drain-each additional 100' 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Total each additional$100.00 or fraction thereof,to O*her Inspections or Fees . Fee(4!) and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer ,Plan Review olr I"1» uulg III3tailaliops r : Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" -3" ISometi'l oI„Rsci I . am 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 rl Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCM Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. UeSR.- Val\ Print Name of Permit Applicant + Z ature of Permit Applicant Date Permit#: ,40,71617-11-11 Address: ,r s in,ys 1 y.. Issued by: Date: f = This Copy for Permit Offices City of Tigard •111 " COMMUNITY DEVELOPMENT DEPARTMENT V 0 T 1 G A R D Building Permit Review — Residential Building Permit #: p) 70 L(,._.60,2$- ' Site Address: ft&S/ S40 /J ) Project Name: t' ,/ /9 G,, ,;'l__ Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review,l r---,3, Proposal: //' . 47'x'm712) -t duple, L, /Verify site address/suite# exists and activ npermit system. 0/Aver Terrace Neighborhood: V No ❑ Yes,See River Terrace Review Addendum Attached Siy Plan Elements: IaliThree(3)copies of site plan �xisting structures on site V.to 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 .rth arrow lId It;'ty locations(required for new,may apply for additions) to address,project or subdivision name and lot number {•, i,cation of wells/septic systems r)1 .plicant information(name and phone number) Oisting trees to be retained with drip line,and tree 11 ot dimensions and building setback dimensions protection measures �' t area,building coverage area,percentage of coverage and V.I1'4, eet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) NI Street names Okoperty corner elevations (2 foot contour lines if more than 4 foot differential) El Clean Water Vrvices—Service Provider Letter(lot platted prior to 9/10/1995): / Required: Yes,applicant was notified ❑ No Received: ❑ Yes No Public Facilities Improvement(PFI) Permit: / 4Required: ❑ Yes,applicant was notified tl No Applied For: ❑ Yes ❑ No,stop intake andUseCase#: /4-1)02("))4,— /��) qd oning: �` , -C- S - Setbacks: Front /67 Rear /,S' Side S Street Side k1,qGarage /49_0/0 fff 1L.andscape Requirement: ot Coverage Maximum: Building Height: Maximum Height S / Actual Height // b fi lkisual Clearance Pasements ensitive Lands: El Yes CI No Type Jrban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: ___,_ __. , Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved El Not Approved Revision 2: El Approved El Not Approved Revision 3: El Approved ❑ Not Approved I:\Building\Forms\B1dgPemritRvw RES 060116.docx Building Permit Submittal Original Submittal Date: _ ! fu Site Plans: # Building Plans: # Building Permit#: nter •ding��permit--#above. �'. Workflow Routing: arming Lr;ngtneering L- ermit Coordinator ;M• g Workflow Sign-off: —,�, �ig,,n.-o-ff for Planning(include notes from planning review) Route Application Documents: L_ ngtn!eering: (1) copy of permit application, (1) site plan, (1) building plan and origin plan review routing form. wilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: 2 . 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: _ dz. 22 Date: 7-J1/--b 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 ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\B1dgPermitRvw_RES_060116.docx