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Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 471 _ Request for Permit Action NOV 1 7 ?I)16 Y ki k. f ) 9 ,A t i-I G A R D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 + i,,,, 1tfrd cit.;'4,_ 1 TO: CITY OF TIGARD V 0 Building Division /x/92q// ' ,6 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fa • 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner Applicant ❑ Contractor [❑ City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) (?) -7C]5.- � � jL5 i.& /-� C Mailing Address: 77 5c &e,-0, 44 v City/State/Zip: 11(5- ) oe. 9-17-- -5 Phone No.: 3 7 06— 07-1, PLEASE T1 ACTION FOR THE ITEM(S) CHECKED (1): a. CANCE V OID PERMIT APPLICATION. 11.0"""'- NRMIT FEES (attach copy of original receipt and provide explanation below). 161 INVOWeR FEES DUE (attach case fee schedule and provide explanation below). • REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 1 GJ-r-0-0 L(D -on 3 a /-SAW /, -Do; � Site Address or Parcel#: 1 C 0 �� Gia ('r-�,,.'`// Project Name: Ca e j(&) , Subdivision Name: r` I ( I Lot #: ( O EXPLANATION: 1. iL) Pd , t_C) ----L________ 26-- - .„ _s-7-,,2-0/6 --6,e ...e / Se'/Z- /k -e7n /4. r. la Signature: Date: 1 ( . (7 ' l ::,, Print Name: (Q * (2.1 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 it , ,e, ICY !IF° Route to Records: Date A,'-,ze, /, 1 -1,1-, Refund Processed: Date AI/ B /.h,- Invoice Processed: Date 4.y �jA, B ;;/a" l/�r Permit Canceled: Date f oxB i Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_0' 314. oc City of Tigard • COMMUNITY DEVELOPMENT Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TIGARD INVOICE TO: Westland Industries, Inc. Customer ID: 30235 Attn: Jim Standring Invoice No.: INV2016-00018 12670 SW 68t1i Pkwy, #400 Invoice Date: 12/29/2016 Tigard, OR 97223 Date Due: 1/29/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2016-00329 15022 SW Corbin St. Corbin Estates,Lot 10 $1,024.37 Fees due for plan review completed prior to request to void permit. Invoice Total: $1,024.37 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2016-00329 Customer ID: 30235 Site Address: 15022 SW Corbin St. Invoice No.: INV2016-00018 Project: Corbin Estates,Lot 10 Invoice Date: 12/29/2016 Date Due: 1/29/2016 Invoice Total: $1,024.37 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse. Please mail payment to: City of Tigard,Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 I:\Building\Accounting\Invoice.doc 01/14/2011 CITY OF TIGARD FEE AND PAYMENT HISTORY g IN ill 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD MST2016-00329 - 15022 SW CORBIN ST, TIGARD, OR 97224 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Plan Review 230-0000-43106 $751.34 $751.34 $750.00 8/16/16 Check 405669 $1.34 DC Provision Review, SF-Ping 100-0000-43112 $90.00 $90.00 $90.00 Plan Review 230-0000-43106 $933.03 $933.03 $933.03 Totals for Fees $1,774.37 $1,774.37 $750.00 $1,024.37 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 405669 Check 1181 Westland Custom 08/16/2016 $750.00 Homes LLC Total Payments: $750.00 Balance Due: $1,024.37 ,_ \ 44 i, ) 1 Building Permit Application ' Residential /2/2y/ 7. FOR OFFICE ISE O\El lig 4 City of Tigard RECEIVEDRDeceived/By: 7 ge /4 S' ' Permit No.:HTp10/6-OO 3,96 13125 SW Hall Blvd.,Tigard,OR 97223 r Plan Review o ,,n ? m Phone: 503.718.2439 Fax: 503.598.1960 AUG U 2016 Date/By: C. Other Permit: .c7 �P'��g 1'1 C.A R l7 Inspection Line: 503.639.4175 Date Ready/By: ,� f Q Juris. See Page 2 for Internet: www.tigard-or.gov Notified/Method: )16 '7Z I I Supplemental Information CITY OF TIC�ARE) :S. TYPE OF BUILDING DIVISION REQUIRED DATA:1-AND 2-FAMILY DWELLING 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 ❑ ddition/alteration/replacement Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. and 2-family dwelling 0 Commercial/industrial Valuation: $ 1 Com' 41 ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 6 D.,7Job site address: I So 7,.�,, ��� ,jJ New dwelling area: ..496i4 square feet City/State/ZIP: 1'I "t l2-y2J Garage/carport area: 41, square feet Suite/bldg./apt.no.: Project name: r g.-&1 J 4A Covered porch area: ` _ square feet 6 3 Cross street/directions to job site: 53/�T 0�JOp .m C 9- square feet j 8 i it Other structure area: 1�8 square feet/S37 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: e_ele.l 113 c-l-5 Lot no.: 1 0 Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet Ittl-PROPERTY OWNER 0 TENANT Number of stories: Name: --1-- y_[+ Type of construction: Address: I —GO O S: \ ---27_ 1J,5 -k4; ) Occupancy groups: City/State/ZIP: l !(j- 'L-t ©/2_ q�',),--3 Existing: Phone:( 5-2))...3 (03 -742_1 Fax:(S-2) 6, `t 62-39 New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: A �} t S I GS wry/ (Mase refer to fee schedule) i Structural plan review fee(or deposit): Contact name: r,.. 'I ( s _ ( ��,I `� ( �"' '�� � �b FLS plan review fee(if applicable): Address: .uS L1� Total fees due upon application: City/State/ZIP: C-A� b4.., q�Z-3C Phone:( �3,_?65 -OGZ4 Fax::( � 5-eig _ etp 8\ Amount received: 7 E-mail: 5 (,),„. 124414)� e. . T t 1 x ,. cl '\ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR ,,p roof-top mounted PhotoVoltaic Solar Panel System. Business name: CillC� 'o , 5 , C-- e.€ . ....)3(.( ` Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: ( Z(070 SCcPe, {c,L6(� Solar Installation Specialty Code checklist. City/State/ZIP: ! ��n, '?'? l Permit Fee(includes plan review $180.00 ��f tY�� -• Z�-J and administrative fees): Phone:(e2:,; 700 .. v4zi... Fax:( SZ —. 5125 - c'cg ( State surcharge(12%of permit fee): $21.60 CCB lic.: -302Total fee due upon application: $201.60 Authorized signature.�/0/°"°° ' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. (3.1 NI. / ( d� �yy.— *Fee methodology set by Tri-County Iiutldtng Industry Print name: ii/ iN-� Date: Il• Nc. Service Board. , Building Permit Application Checklist One- and Two-Family Dwelling FOR 011 l( L 1 S 0N1.1 Received City of Tigard Date/By: Permit No.: - " 13125 S W Hall Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 TIGARD 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No y',N 1 Land use actions completed. See_jurisdiction criteria for concurrent reviews. /5 ■ ■ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. K. 0 0 3 Verification of approved plat/lot. ❑ ❑ 4 Fire district approval required. Name of district: • (a' 0 Et, 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 6 Sewer permit. E 0 0 7 Water district approval. 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. ((Z 0 0 9 Erosion control,❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- []� 0 0 basin protection,etc. ///// 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state (��' 0 0 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 Q 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, Pf 0 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 12' 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. re 0 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- CO ' 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists i3 ❑ 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 2 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ia" 0 0 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 V 0 0 architect licensed in Ore:on and shall be shown to be a.•licable to the •ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x II"or 11"x 17". in ■ • 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 12/ 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ( ❑ 0 _ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 fi2' 27 "Drawn to scale"indicates standard architect or engineer scale. 0 r 0 El 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 (� and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, V 0 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. • I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) i 4 Is : Electrical Permit Application .. _ FOR OFFICE USE ONLY �1CityD f Tigard RECEIVED �� ReceivedrEINIIIMINNEIM II O 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C' Phone: 503.718.2439 Fax: 503,598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 AUG 16 2016 Ready Date/By: Juris: la See Page 2 for '11GARD, Internet: www.tigard-or.gov v Notified/Method: Supplemental Information TYPE OF g r (O(F T1GAH!D PLAN REVIEW VfNew construction 0 Addition/alters n/Q12c'Lltieflt�slON 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 El Other 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 ElCommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ngs. Multi-family 0 Master builder ❑Other: amps for all other installations. butd 0 Fire pump. Installation❑ of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived Job#: Job site address' //��.� 4%,,j / l ❑Addition of new motor load of system. (6V��L' cs,�; 1 N 5r l00HP or more. ❑<.A„«E «1.2„.<1 3» r ► e)(7,-7:1, ❑Six or more residential units. occupancy. City/State/ZIP: 7 ' '� ®R.,a > " ' 0 Recreational vehicle arks. %Il' ❑Health-care facilities. P 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: SI 4-r- h. 1-2,64I.JuvA. FEE SCHEDULE Description 1 Qty. 1 Each 1 Total 1 New residential single-or multi-family dwelling unit. Subdivision: CZe\-311J "eSlitree7. Lot#: )6 Includes attached garage. 1,000 sq.ft.or less 1 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion % 33.92 1 DESCRIPTION OF WORK Limited energy,residential F ej �J (with above sq.ft.) ) 75.00 2 N Limited energy,multi-family 75.00 2 residential(with above sq.ft.) ROPERTY OWNERRenewable Energy 0 See Page 2 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 3"e"'�g41-1-44... rj�� , ,a 200 amps or less 100.70 2 Address: 43t , p o •r�/I' ."3 ' �a 201 amps to 400 amps 133.56 2 1-1 n 401 amps to 600 amps 200.34 2 City/State/ZIP: 1{ 2,,,, Q?yam, 601 amps to 1,000 amps 301.04 2 Phone:9'3,—tow. v Fax:( sa 6 2V .0 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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,Iease,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 LICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: +� , ,e ij� u�� j, above service or feeder fee, 7.42 2 w each branch circuit Contact name: )ak . B.Fee for branch circuits without ✓ 1V ��M t�'F�^` � service or feeder fee,first Address: t 2_1010 .& 6 e 144 ski� 56.18 2 KG// branch circuit City/State/ZIP: "t 04 q'7 ?-3 yEach add'1 branch circuit 7.42 2 (�, �tj (9). __.9t3.,(40151 t3�p 151 Each manufusactured (service or feeder not included) Phone: Fax: : Each manufactured or modular G. , awl_ Recondwellinect t only and/or feeder 67.84 2 Email: C"gI/l_ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: g E4 Du-p Du-pG/t",c_ti l aG Sign or outline lighting 67.84 2 Address: . P. 1 . �b 6G`s."- W� Signalnel,circuit(s)or ionergy 0 See Page 2 2 V panel,alteration,or extension. City/State/ZIP: c ��,f r 17,� re_ Each additional inspection over allowable in any of the above r� 1/' �J �, • Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:(IV6�!/ 7,‘,.„, 57,14 Investigation(1 hr min) 90.00/hr / Industrial plant(1 hr min) 78.18/hr6114VA y e.A7OL 'CAiik Inspections for which no fee is 90.00/hr CCB Lic.: 1 Oo 10)y I Electrical Lic.: 2 3,kil &prv.Lic5l 042)5 specifically listed(Y2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signa r ui d• A, Subtotal: Print name: 'M"`�I 3> Date: K) (L b, 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): ^ TOTAL PERMIT FEE: Authorized signature: I/ \ C.--1,..n-..-0 - f This permit application expires if a permit is not obtained within 180 Print name: Date: ' 1a ( days after it has been accepted as complete. 1:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB f i Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Description new° Qty. Each`d TTotal ; R 3' Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 5V—Garage Door Opener* >100 to 100 kva 552.26 2 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(Y:hr min) ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* • ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:18ui1dinglPermits1ELC_PermitApp ELR_ERE.doe'+R iw06%17/1015 'Mechanical Permit Appiic I D FOR OFFICE USE ONLI' IIIIICity of Tigard AU •'1 6 I I ` -■ Permit No.: r t f��/r!'co✓ / 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.58 o� ��GARD Date/By' Other Permit: T I GA R D Inspection Line: 503.639.4175 BUILDING Date Ready/By: kris: ® See Page 2 for Internet: www.tigard-or.gov DIVISION Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work KNew construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ,J1-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: Air conditioning / 46.75 Job site address: ' On,' ,i " Furnace 100,000 BTU(ducts/vents) ✓ ( , 46.75 City/State/ZIP: r- `�rPi> 4(2. Q727„'3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump / _ 61.06 Suite/bldg./apt.no.: Project name: Duct work / l 23.32 I Cross street/directions to job site: ra9..,NxHydronic hot water system ._ 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: c,t51` At. Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater / ( 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 IQ e Fluevent for water heater or gas fireplace 23.32 Log lighter(gas) , 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNER 0 TENANT Other 23.32 . n Environmental exhaust and ventilation: Name: �� T �{/ Range hood/other kitchen /` ��' "`��� �Xf s'�-� equipment 33.39 Address: (VO 66 S1 -72-2.14� If Z a Clothes dryer exhaust ✓ I 33.39 City/State/ZIP: e� Single-duct exhaust(bathrooms, ,/� t �0 1`,�� � -( �'�� toilet compartments,utility rooms) 4 23.32 Phone:(��..- to 3' v t Fax:( J t924— (32-39 Attic/crawlspace fans 23.32 tt PPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: �^ ( e_{ $14.15 for first four;$4.03 f"...each additional Contact name: ^ ..!! Furnace,etc. , J s N OCT— r/Gas heat pump l Address: \2470 J.1 (0g °100 — Wall/suspended/unit heater City/State/ZIP: t,&Aar, t.Je.'" q7;978? Water heater / i Phone:( 9)3 . -Ito . 0(02t, Fax::(Q!)? cG ei(`)8 I Fireplace ,/ ' Range t Email: u3e5t1A\11) e L' -\ _Barbecue CONTRACTOR Clothes dryer(gas) (j ,Q Other' Business name: !�Y ���' � ��"`/ � MECHANICAL PERMIT FEES* Address: $eis 4 1101.N Gr' Pf,V jCi Subtotal City/State/ZIP: Minimum permit fee($90.00) 0��� Plan review(25%of permit fee) Phone:( QFax:( ) State surcharge(12%of permit fee) CCB lie.: '2,.0 3 Sa a . 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: UR�� * Fee methodology set by Tri-County Building Industry Service Board Print name: R3ate: I:\Buildina\Permits\MEC PermitAvp 040113.40c 440-4617T(1I/02/COM/WEB) Mechanical Permit Application - City of Tigard , Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including • $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or , • fraction thereof,to and including ' ' $50,000.00. $50,000.01 to$100,000.00 $1,363.71 forthe 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\Pernuts\MEC_PermitApp_040113.doc 2 ' Plumbing Permit Application Building Fixtures FiEsti,IVCDt1o11 our-i( : t SI: oyi.l City of Tigard Received � A q Permit No.:,n/yr / ,_e)O3?. II 111 13125 SW Hall Blvd.,Tigard,OR 9722AU G 16 2016 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 an Review Date/By: Other Permit No.: D T l I.A it U Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov PUILDING DIVISION Notified/Method: Supplemental Information I, TPEIOFWORK .s, ,''wy 'FEE• SCHEDULE New construction ❑Demolition For special information use checklist Description I Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 51C1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath II 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen i 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION,AND LOCATION Site utilities: Job site address: I S 02.,. 53,S x•m r' ,6 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Op... 972.277,. 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 13t ST' Jl, Coue Otol�, Rain drain connector 18.76 �» Sanitary sewer(no.linear ft.:_) 1 Page 2 Storm sewer(no.linear ft.: ) J i Page 2 « Water service(no,linear ft.:_) ,/ 1 Page 2 Subdivision: -�t & 51`i� I Lot no.: )� Fixture or item: Tax map/parcel no.: s -✓t / Backflow preventer 31.27 O OF WO gx t , ., Backwater Valve 12.51 .t,ktr:° ? .PTI„o>. Clothes washer / t 25.02 Dishwasher ✓( 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 7: PROPERTY OWNER„ ;;, ❑ 'lC Expansion tank 12.51 Fixture/sewer cap 25.02Name: V v '■ +/ _ Floor drain/floor sink/hub 25.02 Address: 06 3, .N .-72..... Awe) Garbage disposal ✓/ I 25.02 City/State/ZIPr La:AV OR--- q72.-"X 3. Hose bib ,/ 25.02 Phone:��` � .►- 1.1..,-2.49. Fax:( 4,,4-62)3/ Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: IkJl 2v•0u S ,,Se • Medical gas(value:$ ) Page 2 n- 7 �"' - Primer 12.51 Contact name. i i2[iJ� (J T� Roof drain(commercial) 12.51 Address: I 7V� C(A to is Q G Sink/basin/lavatory ✓ aj 25.02 City/State/ZIP: I 'Ur'1��t7 Q? Z3 Solar units(potable water) 62.54 Phone:(2:1 [ $6 0(024, Fax::(/ g . A\ Tub/shower/shower pan (5-),//741.# 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater ✓ I 37.52 Business name: (Z. pat met 0 6r- (0(, Water piping/DWV 56.29 Address: l -17-eiS-17-/i679.( el) Other: 25.02 City/State/ZIP: 5 ev,, tf2"%'"'i�✓�Y of.-,a 6?7140 Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) CCB Lic.: q�3 Plum Lic.no.: Vit 20S e95 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: ,/ _V Date: This permit application expires if a permit is not obtained within 180 days G u Iwo L • 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: Site Utilities Qtr: 'tee tea) 'Total Square Footage: Permit Fee:, Footing drain-1"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit'Fee: 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 "or; § Fee teat Total each additional$100.00 or fraction thereof,to Other InspectionsFees 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*. -14,.64ew Ofiumbing bitallations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure Drive Tall as defined in OAR918-780-0040. ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 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" • Iso etric ir'Riser"Dili` y am 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard N COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: H 6f 9-D/(p- ob 3?9 Site Address: 150,z . 5c,,; ( .-(o•; ,S4 . Project Name: C-0.-0',‘'‘ ' ''54 --k J Lot #: / 6 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N e SF R— 11 Verify site address/suite#exists and active in permit system. ❑ River Terrace Neighborhood: (No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: RiThree(3)copies of site plan xisting structures on site Site plan must dig on 8-1/2" x 11"or 11 x 17"paper .`Footprint of new structure(including decks)with finished 'J brawn to scale(standard architect or engineer scale) floor elevations J North arrow J CTtility locations (required for new,may apply for additions) ,Site address,project or subdivision name and lot number Location of wells/septic systems Ji3Applicant information(name and phone number) ,xisting trees to be retained with drip line,and tree .JLot dimensions and building setback dimensions protection measures __Jot 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) AlStreet names ,Property corner elevations(2 foot contour lines if more than 4 foot differential) (It-Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified R.-No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: X Yes,applicant was notified ❑ No Applied For: X3.--Yes ❑ No,stop intake Land Use Case#: S(,1—t5 .a u i +-E — 6000 9/ U,l'1- 2 e v i(-t --C1)L _ ,"Zoning. {R - ►{ - ( Setbacks: Front 0 Rear j 5 Side Street Side — Garage Landscape Requirement: Lot Coverage Maximum: -- !$ Building Height: Maximum Height 30 Actual Height ,g(4, • . Visual Clearance Easements Sensitive Lands: ❑ Yes g-No Type f'Urban Forestry Plan ( --Conditions "Met"prior to issuance of building permit Notes: -, A-1-6-4)1,-‘k- - v,N\.aCj,t.-r-4 -L r~. 1 v wt f- _s A-+ p(,-(,s to bC c a LLi C 1 ei --0 e.)rt- ei Ir c,-1 -e ,.s rvxI LL -t-V1c rt 10 .('u.+- coke - toe( Approved By Planning: Chi_A,-. C( ,,,..s..---- Date: E - ! ( --1(,,.- Revisions -((Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Submittal Original Submittal Date: //(p//k0 Site Plans: # it Building Plans: # Building Permit#: Er Enter building pe t#above. LL Workflow Routing: 2'Planning Engineering [rmit Coordinator 12- uilding Workflow Sign-off: C' Sign-off for Planning(include notes from planning review) Route Application Documents: 2' Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Er-Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: Date: 4,4,b Engineering Review Slope at building pad: 82 IConditions "Met"prior to issuance of building permit f2"..Easements (encroachments) per engineering conditions of approval and plat Afr 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 l No LI NOT Approved by Engineering: Date: Notes: WLIZ______ Approved by Engineering: Date: ef5- _ 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: IN -Yes ❑ N/A Parks SDC: !— es ❑ N/A 7CDOK to Issue Permit /,, Approvedby Permit Coordinator: Date: gi?".1- `4 I:\Building\Fonns\BldgPennitRvw_RES_060116.docx