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Permit (166) 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 I GA R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 1�1 Suv DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: 1111 e JULI,CY`n\e\J 19 2021 COMPANY: ?Yb3,(4-,1J CITY OF TIGAVID PHONE: `mil 504 — [0 842D 3UILDING DIVIS ON EMAIL: Donler-r\le ` L .Ccr n RE: 1 135 SW l D3r d Ne_ 1'i-srae-c02Z2 (SiteAddresms) (Permit Number) (Project or sub ' ision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. 3 Revisions: 1a 1,,AS Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. 3 Engineer's calculations. Other(explain): REMARKS: Pt C�� 'PrltCd FO OFFICE USE ONLY Routed to Perm ec Date: 77 L .l a( Initials: Fees Due: [�/ 1i0 No Fee Description: Amount Due: 1(2 [Anr�v� c.1,3 �' $ yS•D $ Special Instructions: Reprint Permit(per PE): ❑ Yes No ❑ Done Applicant Notified: Date: 7/Lc. c Initials: I:\Building\Forms\TransmdttalLetter-Revisions_073120.doc CITY OF TIGARD MASTER PERMIT IIIICOMMUNITY DEVELOPMENT Permit#: MST2018-00232 �► Date Issued: 09/06/2018 T[t;A g�j 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 f ': parcel: 2S1116601501 40 2 0 A061 Jurisdiction: Tigard Site address: 14135 SW 103RD AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 1 Project: LEMLEY Project Description: Relocate kitchen to rear of house, new vaulted ceiling, add a bathroom, replace drywall, insulation &wiring. 6/22/2020: REPRINT to add boiler, gas piping for boiler, range, dryer&barbecue. BUILDING Floor Areas Reauired Setbacks Reauired Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $35,990.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 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 Natural Gas Heat Pump: N Hoods: 0 Other Units: 2 Furn<10oK: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder _ Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 19 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: ALT SF VS R-3 0 Owner: Contractor: LEMLEY,DANIEL M OWNER Required Items and Reports(Conditions) 14135 SW 103RD AVE DANIEL LIMLEY PORTLAND,OR 97224 14135 SW 103 TIGARD,OR 97224 PHONE: PHONE: 503-504-1088 FAX: Total Fees: $1,792.25 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throu AR 952-00 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503..232.1987 or 1.800.332.2344. Issued By: l Y•'1'"IFli-4---) Permittee Signature: G23. '1"9/p t-/ e 7 77r)<t) Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application colt OFFICE 1JSE ONLY Received Permit No.: City of Tigard REIVED eceive it._ ) /�7�� MS—r �� !� 0�1 3�,3 III " 13125 SW Hall Blvd.,Tigard,OR 9 E�j • Plan Review Phone: 503.718.2439 Fax: 503.598.1960 UutG13y: OtherPonnit: T I GAFF) Inspection Line: 503.639.4175 MAY 7 202(t Date Ready/By, turns: la See Page 2 for Internet: www.tigard-or.gov IV' I LU U Notifi.i/Method Supplemental information CITY OF TIGARD TYPE oFB' ki0ING DIVISION COMMERCIAL FEE*SCttEDULE- USECHECI..TAST Mechanical permit fees"are based on the value of the work ❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. f Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: r LI 13s S 1,J (O3 tt,b Av'a Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: ^'j'-'I(7 4 2.4 ,d ttti.. a7`T 2 Ll-f Furnace 100,000+BTU(duots/vents) 54.91 s Heat pump 61.06 Suite/bldg./apt.no.: Project name: L._&r.-\Licy `[3A )4.10054 Duel work 23.32 Cross street/directions to job site: Hydronie hot water system 23.32 Residential boiler(radiator or ✓ VV..) 1' R.- O `F- cVt-! }il n 0Je',n hydrenlic) i 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: Tux map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 ' Flue vent for water heater or gas13 OI l-(c tc &_ 1 tJ+ FL.044 A--- N l-A.. fireplace 23.32 Log lighter(gas) 23.32 • J'} Wood/pellet stove 33.39 - �P �— C 4 S (i P(�6- /v_1L O t, Wood tireplace/insert - 23.32 ,� TO 6- /l%r'N6 Chimney/liner/flue/vent 23.32 Y s -f"'�/ Ctther: 23.32 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: e7)AKA �'- �M L(s y Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 Single-duct exhaust(bathrooms, City/State/ZIP: toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/emwlspaee fans 23.32 APPLICANT 0 CONTACT PERSON _Other: 23.32 Fuel piping: Business name: — AJoM 4, •. $14.15 for first four;$4.03 for each additional Contact name: "P4&)iEL-_- [-,cM(_�y Furnace,etc. Gas heat pump Address: /4// '3S SIA-' tO3q..0 Avt Wall/suspended/unit heater City/State/ZIP: Water heater ! (6Ax o , o rt Fireplace Phone:(503) 501-1- l oY 8 Fax: :( ) Range '/ 1 E-mail:mail: ,'/qN L-6n I...(GY n�. `jvQ('-.Ga A--, Barbecue ,/ t CONTRACTOR , Clothes dryer(gas) Other: Lo v`'t--` :f I3usinessmune: — 0W.,✓6"f— I/✓C- (Le.6T'lu Ps/---- MECHANICAL PERMIT MS* Address: Subtotal Minimum permit fee($90.00) City(State ZIP: N A Plan review(25%of permit fee) Phone: Ft ':( ) State surcharge(12%of permit fee) CCII lie.: TOTAL PERMIT FEE This permit application expires if a peril to not obtained within 150 �,- -- days after it has been accepted as complete. Authorized signature'' -�____ / ' Fee methodology set by Tri-County Building Industry Service Board Print name: TAN( � r- �P'[. y Dates/7 ZdL+ I An uilding+Permits1MEC.PermitApp_(1.40113.doe 440-4617r(I I,02/COM/WEEl) 02/6-,,,+/..n___ ' L 1 /-ri ' -S C4-AI CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit*: MST2018-00232 T r i A.l i r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/06/2018Parcel: 2S111 B601501 Jurisdiction: Tigard Site address: 14135 SW 103RD AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 1 Project: LEMLEY Project Description: Relocating kitchen to rear of house,new vaulted ceiling,adding a bathroom,and replacing drywall, insulation, and wiring in living room,dining room,and master bedroom. BUILDING Floor Areas jieauired Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Leh: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 of Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right 0 Detectors: Yes Total: 0 sf Value: $35,990.00 Rear: 0 PLUMBING • Sinks:;0 7 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Unnals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer. 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 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: 1 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 • Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temo SrvelFeeders Branch Circuits 1000 of or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea adds 500 sf. 0 201-400 amp: 0 201-40D amp: 0 W/O Svc/Fdr: 19 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt 0 ELECTRICAL-RESTRICTED ENERGY SF Residential • Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener. N All N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr. Occupancy Group: Square Feet ALT COM VB R-3 0 Owner: Contractor. LEMLEY,DANIEL M OWNER Required Items and Reports(Conditions) • 14135 SW 103RD AVE DANIEL LIMLEY PORTLAND,OR 97224 14135 SW 103 TIGARD,OR 97224 PHONE: PHONE: 503-504-1088 FAX: Total Fees: $1,701.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are t forth in OAR :::::° thrAR -001-00ou ay obtainaco of the rules or direct quesOUNC by calling 503.232.1987or1.800.332.2 Permittee Signature:Call S03.639.4175 by 7:00 a.m.for the next available(noosedo ate. This permh card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the Job site at the time of each inspection. FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT = r Transmittal Letter lig TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 41/V5 DATE RECEIVED: DEPT: BUILUJ/ING DIVISION FROM: OG+") Le.M icy MAY 12 COMPANY: CITY QFTIt"r ?0 BUILDING DI1Y'c ' By: --i-, IN /C/v) e ,1, tiv ., RE: /It1435 �S'� /c�3- � (Site Address) eer�mit um er ���i /ST-od<e - 9 3 (Project" name or bdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: lt/4�-r re ,..ev)z-z+.76,2,-ve i,‘,0$ FOR OFFICE USE ONLY Routed to Permit Technician: Date: �/�y 6Z-� Initials: Fees Due: ❑ Yes No Fee De Scripti'on: Amount ue: zi ` Pifj "4k -te .g- $ q if,, a3 $ Special Instructions: Reprint Permit (per PE): ❑ Yes -- No ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 CITY OF TIGARD MASTER PERMIT : ' COMMUNITY DEVELOPMENT Permit#: MST2018-00232 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/06/2018 T I " I`�� g Parcel: 2S1116601501 Jurisdiction: Tigard Site address: 14135 SW 103RD AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 1 Project: LEMLEY Project Description: Relocating kitchen to rear of house, new vaulted ceiling, adding a bathroom, and replacing drywall, insulation, and wiring in living room,dining room, and master bedroom. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $35,990.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 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'l 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 19 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: ALT COM VB R-3 0 Owner: Contractor: LEMLEY,DANIEL M OWNER Required Items and Reports(Conditions) 14135 SW 103RD AVE DANIEL LIMLEY PORTLAND,OR 97224 14135 SW 103 TIGARD,OR 97224 PHONE: PHONE: 503-504-1088 FAX: Total Fees: $1,701.61 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 et forth in OAR 952-001-0010 through OAR -001-0090. You ay obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ---t--/ �'i Permittee Signature: ......-- _ Call 503.639.4175 by 7:00 a.m.for the next available inspectio ate. ---- -- This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. „ ` Building Permit Application ';;-'‘t:(,),i:•-:.t V ,_, , Residential FOR OFFICE I SE ONL) AUG 1 ii Z018 Received Permit No.: City of Tigard 4; Nil im imp, du -..,;„ ”,"— ,-), . Date/B : Ili ea 13125 SW Hall Blvd.,Tigard,OR 97223 r ,----i v, , ,-'1 c .! ::°,t.',,,C:','": , Plan Review lal : 8 Phone: 503.718.2439 Fax: 503.598.19691 r.'' ,'", ,''' Date/B • ig i 41. i Other Permit: UARD Inspection Line: 503.639.4175 2.31J;Lt.) ,`-- :- 1 1' ..'' `.-; Date Ready/By: gl See Page 2 for -1 l Internet: www.tigard-or.gov Notified/Method: liM Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING El New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all xAddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. CATEGORY OF CONSTRUCTION Valuation: $ 3 5 (leo xi_and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0 Multi-family Number of bedrooms: of 0 Master builder 0 Other: Numberbathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: j Job site address: (1-j(3.5 $io icgat, ,etu . New dwelling area: . square feet City/State/ZIP: -60,,,,,,„ ,,,__ 172,,Li Garage/carport area: "..--72:. square feet Suite/bldg./apt.no.: Project name: Covered porch area: t,6"--'- square feet Cross street/directions to job site: Deck area: -- square feet Sit)/0 31743 4-- CsiI•1 Viel)C1-44-. Si— Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST I - - 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.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ -1)04.1V-1 --t_ (ft.-)S.J1-k-civ,•--', t•li 11(2-U.)(s / Existing building area: square feet PU-41.0-4/./6 10 L i V, -DP-), 4 Asi&t-1....i 1406- K ar 1o 12.#,An_i St)iottlyn— Sits—pt -._ ?-4/4/i-16 4b0 1/2 Skk New building area: square feet CeLZROPERTY OWNER 0 TENANT Number of stories: Name: ':DdiU - L-c-4-1.LE 4'1 Type of construction: Address: 1413 , sit...) 10 3 on Au 4- Occupancy groups: City/State/ZIP: -176 4 it,) ) 0 rz_ Cc-71:2_,L Existing: Phone:(S3) 6"- 4.„k— Fax:( ) New: Ja-APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name:Dvj t‘A.,.._ LZ.fri..L6 FLS plan review fee(if applicable): Address: i Li.lx S si) 1 cy3 to, ,44 -I Total fees due upon application: 377,st, City/State/ZIP: -1-7t,n og--- c't722-t-) rAmount received: Phone:(563) 6-zy.4 _ I ovt- Fax::( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail:- , A0I...‘4.1 L (.___ . f Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: eilf/A/E- - Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. Permit Fee(includes plan review City/State/ZIP: $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained ..jii ----"'----- within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name:'yvv„,t 6-( Lerpt y Date: Service Board. I:\BuildingTermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) r Building Permit Application Checklist • One- and Two-Family Dwelling FOR orrlcl: LSI. ONl City Tigard Ti and Received Permit No.: 111‘ Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: • Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T I G A R D ❑ Other. Internet: www.tigard-or.gov THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No 1/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. ❑ ❑ 0 4 Fire district approval required. Name of district: • 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. 0 ❑ 0 7 Water district approval. ❑ ❑ 0 8 Soils Tepont. Must carry original applicable stamp and signature on file or with application. ❑ 0 ❑ 9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 ❑ basin protection,etc. 40 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state (it--. ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore.on and shall be shown to be a..licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 0 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) ' Mechanical Permit Application.. -{ 4, c r ,; FOR OFFICE USE ONLI' Received City of Tigard Date/By: Permit No.:I/ /t h �/f1 13125 SW Hall Blvd.,Tigard,OR 97223 rrn ' I6 Phone: 503.718.2439 Fax: 503.598.1960 Ir-t U G I ( 7 018 Plan Review Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175o Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov (s l � a r w 'C < ', ;Notified/Method: Supplemental Information � `y COMMERCIALS FEF)''."SCHEDULE':USECHECKLIST'_rr _"'r5t'PE`(3�'WURK.a. r Mechanical permit fees*are based on the value of the work ❑New construction 'Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. r CATEGORY 0 t 1 TSTRUCTIgN .. , ? . V Palue:$ .• 1<tESIDE1 it%EQUIPMENT/SYSTEMS FBES*'R " (ELI-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. 0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION ,, " nt,i Heating/cooling: ', � � Air conditioning 46.75 / f Job site address: ( L C\xi /t9 wE-- _Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 6 I1 ,0 t UIQ n.7 7 i7,4—( Furnace 100,000+BTU(ducts/vents) 54.91 111 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 0 R u Cross street/directions to job site: Gk...) ® r Y ¢' SIA./ / c ,,, Hydronic hot water system 0)44 / 23.32 'om3 32-- „./ 2__„P Residential boiler(radiator or c6e.-ptiyp tta"/3'-- d s.-- 4-16OT hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 _ Other fuel appliances: Tax map/parcel no.: Water heater t(./ 23.32 - DESCRIPTION OFk;: a °„ ziz:,''"" Gas fireplace/insert 33.39 '* Flue vent for water heater or gas gt'M,C70 ( i ,i,)01'6 IQ're t-iC-1-- fb /I, fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 = x Other: 23.32 ❑ e F RTY OWNER ,- d ventilation � - � � � *° ti x �rn ���` Environmental exhaust an Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms �� toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 's !‘ El APPLICANT 7,4 pit © *QCT PERSON r i- Other: 23.32 . ..t.... : . �”, tiff 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::(--y--- Fireplace Range E-mail: Barbecue TOA I 1. Clothes dryer(gas) Other Business name: ��A6.-7� A 5` S* Address: /4/13Sp,/ /O � AV'rt Subtotal City/State/ZIP: ” ! ' 6,Avt,0J 0 72,2,ci Minimum permit fee($90.00) Phone:(51)3) c'._ `c$ Fax:(---�--- Plan review(25%of permit fee) �`'L State surcharge(112/2%o of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: �6l /4 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total.Valuation: 1..;%ra ,ermit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 * Electrical Permit Application `1 .ry, �� i Foo(ill'ICEt:si O\i.' City of Tigard .. ,.,„ 4 `- 5-.-t, 'eceived Date/B : 11121111EMENI 41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' ll Phone: 503.718.2439 AUG 16 2018 Date/B : Related Permit#: Email: TigardBuildingPennits@Tigard-or.ggv,, Ready Date/By: Juris: la See Page 2 for T I GA R D Inspection Line: 503.639.4175 IntemettW5iw9.ti -ot g(04 t{" Notified/Method: Supplemental Information u_ TYPE OF Wallin G M‘'�MS O • PLAN REVIEW ❑New construction ,Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural 0 0Accessory building Multi-familyMaster builderOther: amps form all other installations. butd ngs. ❑ ❑ 0 0Fire pump. Installation❑ of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: j(„� 3S S 1J ?O , 2 � )1 'im-� ❑Addition of new motor load of system. /v100H13 or more. ❑«A» «E» «1.2» «1.3„ City/State/ZIP: �� ❑Six or more residential units. occupancy. ty -176 Apo J 6 YL q, -i 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: StA.) K.;•?) y-- gig/ Ma FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential k �f �t�� (with above sq.ft.) 75.00 2 l t wl R-(N6 2 l .--r/004-4--) Va` �TL` '-/j Limited energy,multi-family residential(with above sq.ft.) 75.00 2 � ,/Z' Renewable Energy 0 See Page 2 ROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 7.74/-!`c-L-,_ / ,.frr L. i 200 amps or less 100.70 2 201 amps to 600 amps Address: t t,..( w Fes 3 1 3s $ lO AV 200.34 2 401 amps to 600 amps 200.34 2 City/State/ZIP:1`6 411-,_ 0 r q7 2.2'-/ 601 amps to 1,000 amps 301.04 2 Phone:1SO3) 3"®L(--jc)t e Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email:'35 ,J 1....‘,4-1.L-Ey a7 Civ . cow 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 trent,,or exchangaccord' ORS 447,449,670,an 701. 201 amps to 400 amps 125.08 2 Owner signature:!�' C...�I ----Date:Date: /3/� 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, each branch circuit 7.42 2 Contact name:( - B.Fee for branch circuits without service or feeder fee,first 1 56.18 2 Address: j t{(3<, sv..., (.0-3 W 4)f-- branch circuit City/State/ZIP:r.6 Q(t,a , 0"._ 1977-211 Each add'1 branch circuit / 7.42 2 Miscellaneous(service or feeder not included) Phone:(553 ) 3644 - t Ob IS Each manufactured or modular 67.84 2 ' r.w dwelling,service and/or feeder Email: L 9 �_ 6 1`_ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 67-71,<7 -71-- Business name: Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: /�r- .� TOTAL PERMIT FEE: .! f/ This permit application expires if a permit is not obtained within 180 Print name: --al....{6.i„_ (�A„r Date: rAA * days after it has been accepted as complete. Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/201 440-4615T(i1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONO: F: FEE SCHEDULE _, ,, Fee for all residential systems combined: $75.00 Renewable Earn ( Tu Description Qty. tal I Renwable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/hr mm) COMMERCIAL WOR$ • r.... N i ELE&RI tl.( . . 1 T- ES to Fee for each commercial system: $75.00 subtotal(Enter on Page 1): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 Plumbing Permit Application - t,„,,,, „h >s k.r h . Building Fixtures y FOR OFFICE USE ONE\ Cityof Tigard AUG I. 3 Z018 Received - g Permit No.: III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: � �� �� a Plan Review Phone: 503.718.2439 Fax: 503.598.1$60[E Y .x s '.~ Other Permit No.: r ;4 Date/By: Inspection Line: 503.639.4175 i s 1 -t"� C �l r ' T 1 G A R D Internet: www.ti and-or. ov `ti ti - Date Ready/By: Juris: ® See Page 2 for g g Notified/Method: Supplemental Information TYPE 5WORK x4" . . ` FF1E* SCHEDULE 0 New construction ❑Demolition For special information use checklist Description Qty. Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) k CATEGORY OF CONSTRUCT i+* l ',; SFR(1)bath 312.70 'i:1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 0 Accessory ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB ROE INFORMATION * D I.oCA' [oly' Site utilities: Job site address: /L.i 1 3 S �1�J o ,�_ AV Catch basin or area drain 18.76 City/State/ZIP: Drywell,leach line,or trench drain 18.76 ty `L g.vz ,0 t �7Z�1.1 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 sGo i a s>R-n ±- C'1^J MSA LrJ 5 ,' 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: 1 Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 '•:.7.,.., -'''In ;L.',{:. <3, Backwater valve 12.51 DES ,r 00,WORK ° ,s _., *� °. I' i_. ,,/ r max Clothes washer 1 4' ) 14,41--C t14 ) maic- /� I E i )U7 C 140-6c Dishwasher 1 Z,a3 Z frC l0e' S (5f `(XTu Vt /r..) NIA SW,— Drinking fountain 1 Ejectors/sump 1 _i_�PROPE h i y ',Ii :4„4-4.-I : , TEN _ xt , Expansion tank 12.51 25.02 Name: -DA,'\ _ Lem 0_6,7Fixture/sewer cap Floor drain/floor sink/hub t Address: K �� w 10 1” �+ Garbage disposal 1 -2 ,c),- City/State/ZIP: ,� City/State/ZIP: -17'4,05(1-(...0 i V p �--f-"LW-4 Hose bib 1 SO,o'_/ Phone:(�-iy3) &4 !d% Fax:( ) Ice maker (2,5 ) 4„.:,,,..„! , . i LICANT ` $ ` 0 Z F}RS©N '- : Interceptor/grease trap 1 Medical gas(value:$ ) Business name: - Primer 12.51 Contact name: ^) 1,,,,`� Li„ L.G1 �- Roof drain(commercial) l✓ 12.51 Address: 1 Lt('3 S �,., i�ufk.'') d�1,E Sink/basin/lavatory r'{rA �� I 5v.09 City/State/ZIP: /r,t d4,'':? ) d re_-- ��ZZ L-1 Solar units(potable water) 62.54 Phone:(•51s-3) �j , / V Fax::( ) Tub/shower/shower pan /2. s/ E-mail:...7-1,...„ Urinal 1 j � a ` €-6 L.-- .G-.-A. s� Water closet I &,.."..c_7K . ._ . ;. era ti '011; i ,�„ x. .,. Water heater / 37.52 3 7 Business name: £ /t/I✓ Water piping/DWV ,...,- - 56.29 5.6 .LC( Address: Other: 25.02 City/State/ZIP: Subtotal 3 I$cfq Phone:( ) Fax:( ) Minimum permit fee: $72.50 1 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) — Authorized signature: /:1( TOTAL PERMIT FEE Print name: ] ~1�_ 1..—e-'\t--‘y�./,� Date:e /I//3 This permit application expires if a permit is not obtained within 180 days J / after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: $<te ities Qty. Fee(ea) Q�'. S u Footage: p ,„emit Fee: Footing drain-1"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 t"" Storm&Rain Drain-1st 100' 62.54 t�YilSt1011:%: P`erani e: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for �}, �` Qty. Fee{ea) Total each additional$100.00 or fraction thereof,to Otll )r fil e�ctlous or Fps and includin• $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*. for PiumirMg Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for .Replatel . 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 engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ 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" Dla ram ' 3> ptrl<c or`. er,. g 4„ 0 Isometric or riser diagram is required for new buildings -Car Wash Draial Garbage -Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 • a y '� Information Notice to Owners About ''cP1''s , ,�-.,.,�, Construction Responsibilities r_ (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to http://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance:As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address:www.oregon.gov/ccb f/property_owner adopted 9-23-08 This Copy for Permit Applicant Property Owner Statement AUG 2018 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 CCB# 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. Print Name of Permit Applican, ignature of Permit Applicant Date-F./do/6 ate$ /fin/6 Permit#: ^. ice Address: ' iluhv� .t:Vis,`` a • Issued by: Date: E'er This Copy for Permit Offices 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 111 . Transmittal Letter 1 c,n R 11 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ALL y S-orJ A 0M Srylo Qc DATE RECE DEPT: BUILD((ING DIVISION LCL- E SEP 5 2018 FROM: I.J t G C. L/NI (. . -g A GPI I O:.. TIGARD COMPANY: BUILDING DIV NON PHONE: so3 ) So`-' — JoS .S By: RE: 1/iddres dr S u / d 3 Er–(.)c (Site s 429rmiZu-na;.?A LSM t (Project name or division name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: Copies: Description: 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: &,-)G i'-) 66(L 1,-,G x.61 At t FO TICE USE ONLY' Routed to Perm' ec ian: Date: q (p ($ Initials: 44. Fees Due: LU ❑No Fee Descnption: Amount Due: $ 1 Z fan 14.-V4_, $ LiS . $ $ Special Instructions: Reprint Permit(per PE): ❑ Yeso_ ❑ Done Applicant Notified: VDate: .:=t" ('[ Initis I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012