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Permit r; , CITY OF TIGARD MASTER PERMIT ".. s 1 ; COMMUNITY DEVELOPMENT Permit #: MST2010 00061 :TIGARD ' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/07/2010 1,:o.-,.4, , ,,,,_, . Parcel: 2S111 DB00800 Jurisdiction: Tigard Site address: 15340 SW ALDERBROOK CIR Subdivision: SUMMERFIELD NO.8 Lot: 436 Project: Wallace Project Description: 242 sq ft addition BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First 169 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $95,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Ran Other Fixtures: 0 Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Fum > =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 add] 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add] Br Cir: 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: Y BUILDING INFO Class of Work: . Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) WALLACE, DON & CINDY METKE REMODELING & 15340 SW ALDERBROOK CIRCLE WOODWORKING INC TIGARD, OR 97224 17428 SW BOONES FERRY RD Lake Oswego, OR 97035 PHONE: PHONE: 503 -534 -0985 FAX: 503- 534 -0983 Total Fees: $2,658.22 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a of the rules or .' ect questions to OUNC b - • I . 46.6699 or 1.818. 44. / r — Issued By: r./ // ` � � Permittee Signature: � P il II 1.uildr„1g Permit Application ' I aW�R: I " r ^ rml ,, K Irg ; gy {' 'n y1c e(1 01,11 3' ya (11' a p � t " U „{6i -r7w`�r r �x 71 l i ∎4W, Re t,►ldentlal �Yy ne "ts" �� 44 1 OIZ '(� �)1 I y ;l11� N"+ >ea h ” 144,,1 r �i�: mwS�' w���e W�:q - M,tht" .i�'aiM� , 74 City of Tigard Date/By: 5 /3 /d A / Permit No.: AW.__ V 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Reviewly� 1 I ' Phone: 503.639.4171 Fax: 503.598.190 IN y 3 2 010 Date/By: �[P�J Q Other Permit: .1'. 1G n'ItI)' ' Inspection Line: 503.639.4175 Date Ready /By: — Juris. El See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notif d/Met od: 0 t 41 k Supplemental Information BUILDING DIVISION _ P -_ • TY PE OF WORK . REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. �' Valuation: S 000 q , vii- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: 2. ❑ Master builder ❑ Other: Number of bathrooms: 2. JOB SITE INFORMATION AND LOCATION . Total number of floors: t Job site address: 15 340 t •y,(. irizavas . C,l Re t. New dwelling area: 1 f square feet City /State /ZIP: "r t ( W, CSWIL) C/122. ¢ Garage /carport area: altrek square feet Suite/bldg. /apt. no.: Project name: (4)4(,‘,4 GE Covered porch area: Up 7 Z square feet Cross street/directions to job site: Aitellia PC:04 DP-10 a Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ONETI 10 1C t o - r0 C,�- (O,uf 1* Valuation: $ P4u�S Two $ AA,/A4.t+ Bt JMP OUTS Al. 30 Existing building area: square feet b QU 2F g1Ay (Al DOW t N F r New building area: square feet 14 PROPERTY OWNER ❑ TENANT . Number of stories: Name: Dow h d .i 0t14 0Y wA - c Type of construction: Address: 1 y 340 S w At-Da, BRA G t 2, C.L. Occupancy groups: City /State /ZIP: Tl ,„, t) Oa, Q, ZZ 4 Existing: Phone: ( ) Fax: ( ) New: /:. APPLICANT - ® CONTACT PERSON NOTICE .. ' • Business name: M ..T 42 R am00GE t kJ(A All contractors and subcontractors are required to be Contact name: G� �� L -Y.��s licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: t 1 d Lg 5,,y 13c131 FoRIZY jurisdiction in which work is being performed. If the City /State /ZIP: t�t(.ia 0.6u..) We° a. Q 703 4 applicant is exempt from licensing, the following reasons apply: Phone: ( 503) 5 34 08 8 5 I Fax:: (SOS) S 3 4 oq 43 E - mail: gist arto a AllIerKEEZE14 Apt :L Nlr . CCM CONTRACTOR Business name: BUILDING PERMIT. FEES* Address: tit Le) 66 .6�� FAQ`/ P-(, view erejertojee osit): le) Structural plan review fee (or deposit): City /State /ZIP: L Z ® U, 0 ( IL Q `102 5 FLS plan review fee (if applicable): Phone: ( 5p5) 534 aQ ,S I Fax: ( S03 ) J o 9 Q 3 CCB lic.: 61411 7 bo Total fees due upon application: Amount received: 4691 diO Authorized signature: This permit application expires if a permit is not obtained ''` ∎ — within 180 days after it has been accepted as complete. Print name: g+ 0 . LY 6u5 Date: 41 I 1 Z / -Z 0 1 0 * Fee methodology set by Tri -County Building Industry Service Board. F,— 1:\ Buildin \Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB) 4/ z \) / r.. Building Permit Application Checklist " M One- and Two - Family Dwelling k ``: 6 �ioa 4 offFI t i � �'�,', /r" prt ;a ,. Ed�i . ",i r u9,4„ ztl_u. ;° r 1 6Q;;,i r , ii,rt ' " ` C of Tigard Received 74 " "� Date/By: Permit No.: „ V 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: 0 Phone: 503.639.4171 Fax: 503.598.1960 - 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑ Mechanical ;,:161GAKt) - s.4' Internet: www.tigard - or.gov ❑ Other: • l 'A r'4' l.' w ' , a � (f � r ; ,:_ Y , ,� .'"N ) + .- • � ' ( y .) � • t " � , -, r,` \ ) it � ) {' as ; y 2. 1 `7~ ^ .( � 4 .' -i "1 ;,- . 1' �d' ' CS ti I��O' 7 1 :�/ � ' .1:0 ,1,,, .�. .�.�.. ._. r.✓ ' . � I I F i\ - l . r ., . ,V 1a L �lYl' y o' \.. _. 1 \ . ,� t \/ �l 4 9V.7J ,,- irt� aS.t - +. 1. ,a:1'• 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: • ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and. state ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 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 ,- , ❑ ❑ ❑ 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. . .. ,0 ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required . .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 • ❑ ❑ ❑ architect licensed in Ore. on and shall be shown to be applicable to the .ro'ect under review. M °,� s y_s'.tt ? ' 1 , S a u t lu :, - N� t.,rd p 3t Pt • t. h 46- w,UC » I \C ° 'I , l CIl t - m p.,00 �.. .._ , b-.. ,. I {, 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. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. • ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ' ❑ ❑ ❑ 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. 1: \Buil ding \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(I1/02 /COM/WEB) I , , —Ellectrical Permit AmIlication[U 'J 638 a " ' l E� i11. ! rl.��jCz,�r. ' • 4? "ar' City of Tigard APR S ZOO /3 10 ; Permit 1.. - 84/D- Date/By: r i 13125 SW Hall Blvd., T:._�., r. Plan Review - X. f i- „,;i Phone 503.639.4171 Fax: 503.59&1' OF TI ARD r g ..t ” � 1 Line: 503.6 c(� r r T l • See Page 2ror . W. Internet: www.tigard- or.gov : +t IidG h !t� �: t ,: ,� _ �' 1I : l latbtmatloa TYPE OF WORK �„ ' t `- C' PLAN REVIEW Q oa that apply (submit a seise : . Please check ph ms widens checked beim* New construction ❑ Addition/alteration/1'V' :. •- 1 4 2010 []service «readersouampsormae O>sa� ov s stalks. 0u ❑ Demolition 0 Other: . phone the available read =eat 0 Marines and boatyards. N. ` CATEGORY OF CONSTRUCTION CI Y OF " seeds 1 TIGARD c reIampaatI50vattao, o use s. �n (.� /� t I less to ground, or exceeds 14,000 a Caumetnial+tm agricultural 1 - and 2 -fans y dwelling Corinne rcieUindustrial ❑ At ®DYd jVISIO ` ampspll other installations. o c 7s KVA of ❑ Multi- family ❑ Master builder ❑ Other JOB SITE INFOBBIAI'ION AND LOCATION 0 � t separately derived ❑ /Addition anew motor bad of ❑ "A °,'B ; "1-2", °1-3 ^, t Job no.: Job site address lao1: m noes occupancy. (� 3'�O 9W �•� ��' Q Six or mo a tdendai marts. ❑ Reel vehicle parks. t (My/State/ZIP: - n ( k() D Naaahware facilities. ❑ supply *Male for more than 1 Q o �� 0 Halmtdous locations. 600 volts nominal. Suite/bldg./apt. no.: ( Project flame: w eratot.X4641 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: t>aerrogree 1 ow. I Fda. 1 re,.] I • New reddentlal single- or mull - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1.000 sq. ft or less 168.54 4 Tax 1 no.: Ea. add'i 500 sq. ft or portion 33.92 l p limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. rt.) O® RIG Limited esideed energy, (with above sq. 67.84 2 tesidal ( with aove q. R) Services ear feeders mstaflatios and/or Macedon 200 amps or less 100.70 2 Cif PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 133.66 2 401 amps Name: 1_ 4 Joj .AreA"t�a -s[C 601 to 6�amps 200.34 2 amps to 1,000 amps 301,04 2 Address: 1.4k bI Over 1.000 angles or volts - 552.26 - 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I t Owner Installation: This installation is being made on property that 1 own which is not 201 rumps to 400 amps 1 1 !25.08 2 ac intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 anpa to 599 amps creels l6 2 Branch eels - new, alteration, or extension, ge . panel Owner signature: Date: A. Fee for branch circuits with at above service or feeder Lee, r� APPLIICANI ❑ CONTACT PERSON each branch circuit / 7.42 2 Business name: 01-- " B. Fero for branch circuits without service Hama S branch circuit Each fast /' 56.184./x 2 Contact ��� 7� Each aeW'i branch circuit 7.42 2 Address: 1 71.2-43 5w Y Miscellaneous (service or feede L '� _ City/StacdZiP: .-- Each manutlictured or modular L - ArfAr CjUJG3C-1Q 1 (e. ( O '7p 3 dwelling, service eaud/m feeder 67.84 2 Phone: ' ) 5 534 pet 8 5 I Fax: : (sOj) 56'4 09 63 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: Signor outline lighting 67.84 2 Signal circuit(s) or limited - energy I I Business net" THREE RING ELECTRIC ' C- panel, of orc4anion. t� � l � / 0 71 2 Each additional Inspeedon over allowable in any of the above Address: PO BOX 1887. Additional inspection (1 hr min) 1 6625/ hr LAKE OSWEGO, OR 97035 Investigation (I hr min) 66.25/ hr City/SiateJZU PH: 503.624.1767 FAX: 503.670.9965 Mistrial pleat (1 Mr din) 78.18! hr Cal: 173485 ELEC LIC C273 Phone: ( 9 (0 S >aS peenons for whim no foe is i 90.00/ hr specifically listed (th hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELEC IIIICAL maw FEES • s - Subtotal: / 7 , 9e Signature, required: _ --_ -- Plan review (25% of permit fee): l icense no. e: Tj State (12%ofpamitfoe): 2( m 1 , Print name �C tau I S ' a^d' -� TOTAL PERMIT FEE: 1 7 , O Authorized slgrha — ---- '� Pmt npp0ca6on expires if a permit is not obtained within 180 -- - - - - - -- - - - -- , days slier H has been accepted as co Print name:., , Sir—A ." ., , 0,-.3 ....1 Date • Number of inspections allowed per permit. L1aui7dbslPmmi1s1ELC-PamilAppdoe I0101Po9 44e- 461Sf(IIN51COMIWEB U giro , -. 1t" 1g.h e. e..r sw, - miz i t . t a ltp h r �i a� x X4 Mechanical Permit Application ; , :w ,t "'n .i l �c,., ) Y 1( l" Mc4 :1 1, 1 r `� . ,'7�1 l.lty of Tigard Permit No.: T � _ , ye i �.,;, ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' el Date/By: ', Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: ' , I I c i <li' .' Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for ':',%: P.' ''vi Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK • COMMERCIAL FEE* SCHEDULE USE CHECKLIST • Mechanical permit fees* are based on the value of the work ❑ New construction ra Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS; FEES* E 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning Job site address: 1 53 +0 W A U 0 15112. G' (LGI.E (requires site plan showing placement) 46.75 City /State /ZIP: T I,(.91Al20 1 C 0 11 Zj 4 Fumace 100,000 BTU (ducts/vents) 46.75 Fumace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Lt.J 4- Heat pump 61.06 Cross street/directions to job site: 0-13(205 - ® (, Duct work 1 23.32 ' 32 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 Subdivision: Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION 'OF WORK Water heater ( 23.32 23.3Z- Gas fireplace 1 33.39 '33,7 (0 X ( fo AO 0 l Q'L ®J Flue vent for water heater or gas 3 ZJMIP CUTS fireplace 23.32 Log lighter (gas) 23.32 ENIZ ZACZ Rigor- 2N12- Wood/pellet stove 33.39 Wood fireplace /insert 23.32 RI PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: pe>N * Gluey W e,w 2 Environmental exhaust and ventilation Range hood/other kitchen Address: (5 3 4 St,A.) A-L®�$ - G R-(L equipment 33.39 3� City /State /ZIP: 'l'1 o q72 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, ' ,{ Phone: ( ) Fax: ( ) toilet compartments, utility rooms) Z. 23.32 " jj 1c. 14, APPLICANT 0. CONTACT 1PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: IA 1? 11,1 CCU:a-44-AZ- Fuel piping Contact name: 174 L$ b w eotsziwaS 24-Y $14.15 for first four; $4.03 for each additional Address: L.- A1/4 c 7 - 1 "103 5 Gas h ea t p Gas heat pump City /State /ZIP: e.1C. 1--/(OJ S Wall /suspended/unit heater ( i7 s-J� l a� Phone: Fax: : ( ) Water heater Fireplace I (4,(5 E -mail: Range CONTRACTOR . Barbecue • Business name: C �,�(,, t it- Clothes dryer (gas) Other: Address: p .0 , (3p-i. f4 33 MECHANICAL PER_MITIFEES* ' . City /State /ZIP: (/ L A GV. CP. Q 70 1 Subtotal ( ?'4, a( �" Q € Fax: (50 ) (aSO 3 4 U Minimum 25 %it fee r mit fee Phone: ($03) 1r+ � � 1 q / 3 � Plan review (25% of permit fee) CCB lic.: G7 Ct C, � / / p Ire State surcharge (12 %of permit fee) '0,y'( u 6 1 !!! TOTAL PERMIT FEE 1 1 : i This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board 1:\ Building \Permits'MEC- PermitApp.doc 10 /0)/09 440- 4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new 'commercial buildings require 2 sets of plans. I:\ Building \Permits\MEC - PermitApp.doc 10 /01/09 2 Apr 13 10 09:32a GEORGE DAVIDSON (503) 643 -0633 p.1 RECEIVE! Plumbim Permit A lac E NED, . , _ Building Fixt ores , , ` " , 1,4, 1 131. r) E 1 o lti,, 1 �1 .t) \1i1 I r M i ' .44' �� �# °' City of Tigard APB 13 20 '�IT'Y OF ! �, ` 'I `' �r � �� ^ � -� �� �' �: t _.. J ` 131 SW Hall Blvd., • : ., ' r4 4t_�9!�! / !13 . Al Permit No: rave.- / P" I Phone: 503.639.4171 I t TIC�•DING f •ai •!Lr" Date/By: °Uri e No.: 0 " t !..: inspection Lice: 503.63 • . • • i n 't DMS1O} Date Read ",rw:t Oi i1zsiil Internet: www.ugardor.gov Notifi /Metlwd 6t1 See Pale t or / tS 9a µpkmen 1a1 1 f ntorasaHao I TYPE OF WORK FEE" SCHEDULE ❑ New construction ❑ Demolition For vela[ izionr adore use eb clef kN Description r Qty. I Ea. 1 Total 'N.. tQ Additioaf lteratitmtreplaoement 0 Other: New 1- 2 -famay dwe11k gs (includes 100 ft for each utility connection) ' CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 VI 1- and 2- family dwelling ❑ Commercial/industrial strial SFR ) bas' 437.78 ❑ Aoaexmrybuilding ❑ Multi-family SFR (3) t 50032 'LC') 1 Each additional batb/kitchcn 25.02 bo 0 Master builder ❑ Other. Fire sprinkler sq. R) Page 2 (iQ JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 4 0 o Catch basin or area drain 18.76 1Q c . . City/State/ZIP: e/ZIP: �• t ta �( j (j2 Q�L7 Y+�eil, leach litre, linear trench drain 18.76 - l t- F ooting drain (ua linear fl.: ) Page 2 i_ \ Suite/bldg. /apt. no.: I Project name: tA Manufactured home utilities 50.03 Crass street/directions to job site: Mantes 18.76 A1-1:32R ra t Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _J Page 2 Storm sewer (no. linear ft: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision Lot no.: Fiertare Tax map/pan:el no.: 1 DESCRIP Backfkral prrrantex Backwater 31.27 (OF WORK �m 12.51 �� Clothes washer r 25.02 26, tOt - - -. -- -. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 1;6 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: 06N 4 GOV t / LA' AAA- 25.02 ' Address: 1 5 3 4 9 w i( , (2 . Garbage ge disposal 1 25.02 Z r sink/hub 25.02 a� `�'6' "� q 12;2-4 dispo , v Z C�ty/Slatr ILIP: On- Ho bib 25.02 Phone: ( ) Fax: ( ) Ice maker 1 12.51 1 Z+ �I ❑ APPLICANT 0 CONTACT PERSON !Interceptor/grease trap 25.02 : Business name: j e �� � _ Ul m Medical gas (value: $ ) Page 2 s "t Primer 1251 Contact name: 042$ Sta.) e �7.L -Y Roof drain (commercial) 12.s] Address: la-Seer--0- C36(A. 4.tf) ( 91034 Si wb.inRavettsr 2. 2s_o2 , oq City /State/ZIP: ,±� Solar units (potable water) 62.54 Phony ( t.f O 9 7 Fax ( ) Tub/showvfshowerpan Z 1251 2.6, Oz_ E- rrmii: Urinal 25.02 Watts closet 25.02 CONIBAC OR 15( '37'2...- tea',, Water beater t 37.52 , Business name: (,-' • ,t yQ u (t`r ) Pt:-C) ILL* Water piping/DWY 56.29 Address: 2Z{aSs Nw t 13 Th tie Other. 25.02 City/State2IP: Pc9R Q12' 'VP 22.01 subtotal I 75, i ? Phone: (S0;) (04 3 - i ( Fax: ( 903 ) 1 743 ,0 co 33 Mlnirmmm peatrtit feet S7250 Plan review (25% of permit fee) CCB Lie.: 4 3 � Z 1. ,‘, 4 _ ,_ Plumbing Lie, 3A -1 P� no.: State surcharge (12% of permit fee) Z( d Li Authorised signature: 6 fi� J 1 --- 7tt 111 TOTAL PERMIT FEE ? 9 s I .5 Print Dam u Date 4 13 � O l4 This parade appReatiaa expires /W a permit is not obtained with] a 18o days . ir - _ p & r, • s Q triter It too been accepted as csmplete. .Fie methodology se by 1a.Co taty Budding industry Service Board. liBt intiperreurP,1Nr . r 1Appdoc 10 161jtOHlVt0 1 IE3) C t• trisrwiHGS /Ito f stfAt-tt, - `/ 1 -,/ lle . coHpITIOW cH rc1-_ . rliois RECEIVED ..._, ift _ab . 1-rNe , .-- APR 1 3 2010 ' CITY OF TIGARD s I P 1 F g 20 ' BUILDING DIVISION ► -vT + oN \\ ' 0 * r L li o k til 0 t f-1441'5 E r ., \._________ . _-- --- Irk ia" a -... - I. oIra PLAr+- offilwi k _ ... • n , fCar r/ ` _ 4, -6 fTC"IZI ©!z tl.I<�f'`"1' .� �Tl;gIO� EI- E�� ./i6,'"'N, Pidoi IN/ �Ot 7. ItaT5Flog 11,o� T©1 1- CITY OF TIGARD - SITE PLAN REVIEW ' , 6jOI,EG ff t� BUILDING PERMIT NO.: Ns r'2 GI✓ip(ol Q" PLANNING DIVISION: Required Setba k s: Approved ❑ Not Approved CITY Of TIGARD - SITE PLAN REVIEW Side: T Street Side: /D , BUILDING PERMIT N0: -' Front. _,,2_ Garage: Rear: ' / t. 1 Visual Clearance: (] ❑ Not Approved Street Trees: pprobad 0 Not Approved "viaximum Building Hei,ellt.. J1� feet Protected Trees: QApp caved ❑ Not Approved - WS Service Provider Leger Required: ❑ Yes ❑ No —DI : lor,`rl P Date: 4 /-/s - a op ❑ Rgceived Notes: j BN : Date: ' 7 ( 31, 0 ENGINEERI EPAhTPENT: Actual lope: % Approved ❑ Not Approved 'tom BSI Da Site PI Approved ❑ 7pproved c:a, By : Date: / ° i -- 1...- News: Ii—r42 Sv*I At.Pel 600K- C tgc L Tr& 4 olz• 91224- 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. k` BUILDING DIVISION ' ° tT I G J R D --____, TRANSMITTAL, LETTER TO: DATE RECEIVED: DEPT: : UILDING DIVISION RECEIVED D MAY 1 2 2011 / FROM: glGt -t- 1) (1t/ CO CITY OFTIGARD BUILDING DIVISION COMPANY: (v K e ev\A a) 0,1 PHONE: 503 c 34 O q SS By: -6r RE: l S 3 4.0 Su.) Al--D w2-Sec D Y- ie 6 ' Zo t o - 000 & 1 ' (Site Address) (P y i ' ase Number) w CA-••le (Project name or su division name . - i lot number) ATTACHED ARE THE FOLLO '' ING ITEMS: Copies: Description: Copie Description: - Additional set(s) o pl. s. (l Revisions: Cross section(s) d det: ils. V Wall bracing and/or lateral analysis. Floor /roof fra g. Basement and retaining walls. Beam calcula 'ons. Engineer's calculations. Other (expla'., ): c( 5 REMARKS: M I . is C 6A1 1, t i ---A' i 02. IN vkt.c- 1 M v t, - c' ( ) NI dl ea. ) ,r+ b Bart-i- Dl^ } ere_ 7 / FOR O FIC USE ONLY - Routed to P it ici ` N Date ('- t Initials: Fees Due ❑ Y s o Fee Description: Amount Due: $ • $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes / Do Applicant Notified: Date: 54 /1 a Initial t � D40 1:\Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07