Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
CITY OF TIGARD MASTER PERMIT •Wry " a COMMUNITY DEVELOPMENT Permit #: MST2010 -00072 *'r Date Issued: 05/19/2010 T f GARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 25111 BC04900 Jurisdiction: Tigard Site address: 10205 SW MURDOCK ST Subdivision: Lot: 0 Project: Mitchell Project Description: 2 -story addition, garage and habitable space above. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 21 Bathrooms: 1 Second: 0 sf Garage: 468 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $56,715.96 Rear: 0 PLUMBING Sinks: Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 1 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 1 Garbage Disp: Water Heaters: Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: Heat Pump: N Hoods: Other Units: 1 Fum <100K. Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: 6 Ea add l 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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: Owner: Contractor: Required Items and Reports (Conditions) GALICH, PATRICIA & OWNER MITCHELL, MICHAEL W, 10205 SW MURDOCK ST TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $2,267.99 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 i ordgTro 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. TENTION: Orego law r ' es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are se forth in OAR 952 -0 1 -0010 through OAR 952- -010 . Y may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80,,/:32. 344. Issue By: K._ frY..it/(4.. Permittee Signature: 4 ( -- Information Notice to Owners About .,� �' nstruction esponsi ilities : . ! r ti_. (ORS 701.055 (5)) 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 700 Summer St NE, Suite 300, 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 12 -04 -07 This Copy for Permit Applicant • Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) 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: 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 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 Applicant S 9 / • nature of Permi • pplicant Date Permit #: HST Act 0. 0On7 Address: /19.26)5 A,A) ��4- 7 E 5� ` •'Ir // ee,12 62- 972A� ., ,+„1 Issued y: 4 Date: 67 fr If This Copy for Permit Offices 3 S $wilding Permit Application ' , l ... FT�SS�AfS !:r 1t r - ! sr J a NV Residential 11, � Mr, i tiii i r^ � ` y � y 7 r l OR OI I ICI Util Oy' 1 _.. : �� .�. _ r J'fAK• .�'� usc 3rd - . y.., .�•, < . :_ _ _ _ 3 ,1 ._ ui V `�' Cl of Ti and Received n te� }y Permit No.: 5T 0/D QW l j `J g DateB : � , 13125 S W Hall Blvd., Tigard, OR 97223 APR . 2 8 2 010 Plan Review �� Phone: 503.639.4171 Fax: 503.598.1960 Date : �`��� JIIJ m Other Permit: I 1 c ' ; -,° \ . 1[1 : i , Inspection Line: 503.639.4175 Date Read :: ® See Pa et 2 for � Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method:0 1 a '' `l_ �++'/ Supplemental Information BUILDING DIVISION _"7.11!` ; , - . TYPE 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. El 1- and 2- family dwelling El Commercial /industrial Valuation: $ l 7 , ) 7 1 ,C?C ❑ Accessory building ❑ Multi - family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: 1 _ • JOB SITE INFORMATION AND 'LOCATION • Total number of floors: Job site address: /0 2 Oz s'(Ai in wivoefe ST New dwelling area: I-0 0 square feet City /State /ZIP: 7/ 6 ,g/C, / ne 9' Z z Garage /carport area: L j 3 square feet Suite/bldg. /apt. no.: Project name: ,nirC iii 64 E Covered porch area: square feet Cross street/directions to job site: Deck area: square feet C 04.4)./Z.- 0 -F / 03 X .' (1/WG ?X Other structure area: E, (,E square feet Zk REQUIRED DATA COMMERCIAL-USE CHECKLIST 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. 4PD /r)4) 0 F 1— Si 64- Valuation: $ Existing building area: square feet wl ry 0° SI/9, , es g1, /f New building area: square feet , ..gPROPERTY OWNER • ❑ TENANT Number of stories: Name: in/ e /fAFL t P ee/4 / ,TCi t_ Type of construction: Address: / 0 2 0 3 - S hi J, ic .. Occupancy groups: City /State /ZIP: -- 64 n 4 9-7 ZZ 47 Existing: Phone: (.(v3 ) G Zp 3 2, ... Fax: ( ) New: ❑. APPLICANT . ❑ CONTACT PERSON . NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /7_IP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E -mail: CONTRACTOR Business name: ' * . //'` BUILDINC'PERMIT FEES Address: OW ( Plea s e +ejer.to j ee schedule) Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): , CCB lic.: Total fees due upon application: _ Amount received: Authorized signature: This permit application expires if a permit is not obtained A � within 180 days after it has been accepted as complete. Print name: , /1 / le / .f it 3 Date: 4 edit) * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(1 /02 /COM/WEB) Building Permit Application Checklist One - and Two- Family Dwelling ,..‘,4--.„4 ti ONLY Receive ...- City of Tigard 111-1 Date/By. Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard- or.gov ❑ Other: , „wT 11E l FOL' LOW LNG 1 "PENIS f RE IZF(1UI'-RC1).HOR •PLAN, REVI!EVV - . e_ 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 J 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 ri ht violations exist. 1 Sit lot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ ere 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 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 ❑ ❑ ❑ 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..Iicable to the •ro'ect under review. 1U RISDIC 1 SI'I C11 ICS 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. I: \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11 /02 /COM/WEB) 5. 8 -' e�; . i 1 T. ag a Sa�;£1°,, r. -,. „. r,. t ,,,,;, i Electrical Permit Application 1 � 1 ( . lalc a9 �r 0-44. t` t j . » „ City of Tigard A/ Permit No.: V 13125 SW Hall Blvd., Tigard, OR 97223 RE ' ` Ian Rev ' ' • C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: • ., :W x 1 Il. Inspection Line: 503.639.4175 APR R. 2 8 2010 Date Ready/By: Juris: ® See Page 2 for - Internet: www.tigard- or.gov Notified/Method: Supplemental Information T YPE OF WO OF jB • PLAN REVIEW ❑ New construction El Addition /alteratioTf/ Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: /02.0 S' ,Std /Y/thCIa7C/C Six or or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 7/64 © ❑ Supply voltage � 97 � 0 facilities. PP Y a for more than / g 619-",6e ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 927 frci GC ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total I New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. f1. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. fi.) 67.84 2 Limited energy, multi - family 67.84 2 412/7 r /DA) f»' Z — s racy O -(p residential (with above sq. ft.) J Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 ' 06,76 2 ❑ PROPERTY OWNER ' ❑ TENANT • 201 amps to 400 amps 133.56 2 _ 401 amps to 600 amps 200.34 2 Name: In /064-6e- L P�Jtati4 /n I rcilta- 601 amps to 1,000 amps 301.04 2 Address: / 0-W S — s' J in v,eaa cr. Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /State /ZIP: 7 6.4,e j OA O�'7 relocation Phone: (5W) / / �ZV T z e 3 Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not intended for sale, lease, rent, or exch acc rdi g to RS 447, 449, 670, a 70 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: '`/ ze e01) A. Fee for branch circuits with / , APPLICANT ❑ CONTACT P RS above service or feeder fee, (y 7.42 M r each branch circuit Business name: B. Fee for branch circuits without Geis service or feeder fee, first Contact name: branch circuit 7 56.18 2 Each add'I branch circuit 54 7 .42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 . - CONTRACTOR • • Signal circuit(s) or limited- energy Business name: /�/ e / �� panel, alteration, or extension. Page 2 2 ��.�/ it) f Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (Y2 hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: 'ELECTRICAL PERMIT FEES Subtotal: (�J,2 Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): (7 , A{3 TOTAL PERMIT FEE: (, Z , ( 5 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: c WlfGz Date: Zg./ZO /e.� • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ,RESIDENTIAL WORK ONLY: - Fee for all residential systems combined .. $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* • n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: . COMMERCIAL WORK,ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling ❑, Other Total number of commercial systems: *•o licenses are required. Licenses are required for all other installations I :\Building\Permits\ELC- PermitApp.doc 10/01/09 7 Mechanical Permit Application ' n ; ' a E ; ' � I OR ()l., lo (,I's1151.4A )i\ I ' .Y,-;Y r� _ _ h....,' &`.v-;ay ess aL's , ..K. ,A.ia.lzsrt_ss�.. 1. s:,:...- L ..i � G . -. ..., :fg- .., - _.,. City of Tigard . (jiii, 4 ' t '' .., = � / DateBy: 7 fir a• Permit No.: 171 i-i'ez9 ^ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ` - 10 Phone: 503.639.4171 Fax: 503.598.1960 APR .2 0 2010 Date/By: Other Permit '::I G A It tV, Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for _ Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information RUII DING nivISION TYPE OF ` WORK . :COMMERCIAL FEE* SCHEDULE USE CHECKLIST 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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit. • • CATEGORY OF •CONSTRUCTION Value: $ 'RESIDENTIAL EQUIPMENT/ SYSTEMS FEES* • ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building • For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND ,LOCATION Heating/cooling Air conditioning Job site address: • 02,0 S ,S' (Ai J'}7if/C/X)CA-- Sr. (requires site plan showing placement) 46.75 City /State /ZIP: 7T p Dz. 97 ZZ 51 Furnace 100,000 BTU (ducts /vents) 46.75 ( Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt.no.: Project name: / rLHeze, Heat pump 61.06 Cross street/directions to job site: Duct work / 23.32 "7 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 Gas fireplace 33.39 D /rail) (J 2- S1 6191 -6 t€ / Flue vent for water heater or gas 1 -&'//4/7/ fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 _ ^^ Wood fireplace /insert 23.32 . s1g- eROPERTY OWNER 1 ❑ TENANT Chimney/liner/flue/vent 23.32 Other. 23.32 Name: In t C 1 .,- 4 4 9 tic/4 7 t � 11LZi Environmental exhaust and ventilation /' I ange hood/other kitchen Address: /OZ)S S 6{ ) /77 l/Z f v Sr & f - / equipment 33.39 City /State /ZIP: 6x1) 0 , 9 7ZZt/ Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (103) (2 Z.0 3 y Fax: ( ) toilet compartments, utility rooms) / 23.32 23.32 - . ❑ APPLICANT . ❑ CONTACT PERSON ' • Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR _ Barbecue Clothes 4tyer (gas) (#6 Business name: Other: G ft-oaf 'E7F. le- / / t-/ Address: �) i' v C 2 MECHANICALPERMIT *. City /State /ZIP: Subtotal 4 (, Minimum permit fee ($90.00) tk' ,."j1, Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: • State surcharge (12% of permit fee) le. he TOTAL PERMIT FEE [eO, 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 10/01/09 440-4617T (1 I/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. • 1: \Building\Permits\MEC- PermitApp.doc 10 /01/09 2 Plumbing Permit Application Building Fixtures ' 1;� t ()N ,VWFV;i° * ; ' , _ x �y } -y p�„1.0 t)1 I ICI.. llsl F ()I�I 1 f r City of Tigard t Permit No.: �/ Q,, I N a 131 SW Hall Blvd., Tigard, OR 97223 Date/By: ,I t to Permit 72` 0 Phone: 503.639.4171 Fax: 503.598.1960 APR :2 8 201p Plan Review Other Permit No.: DateBy: `- Inspection Line: 503.639.4175 Date Read /B Ju ris: ®See Pa e 2 for I`IIGARD, Ready /By: S - • Internet: www.tigard- or.gov CITY OF TIGAo O Notified/Method: Supplemental Information ' - TYPE OF WORK BUILDING DIVISION - . FEE" SCHEDULE ' ❑ New construction ❑ Demolition For special information use check list Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) 'CATEGORY OF. CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 . JOB SITE INFORMATION AND LOCATION . Site utilities: Job site address: (0 24 S' Su/ in v"--0iC' S Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: / � Q CM - 97ZL Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 1 Project name: � / ra �- 5 i _- Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ('eC)) Page 2 (, -2 s" Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 ' DESCRIPTION OF WORK Backwater valve 12.51 /f ,, Clothes washer 25.02 41)0/ % % d a� z- S' V1- 6 Dishwasher 25.02 8� T //j / a�_ - Drinking fountain 25.02 Ejectors /sump 25.02 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: a2, / Gl .(.- 4 %! ICI / r - (�_ Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: /Q Z0 S" SQ.) )71 1J-(-06C /G SS/ - Garbage disposal 25.02 City /State /ZIP: 'i 6 :/,/ 02 97 ZZ 47 Hose bib / 25.02 Gej 2,_, Phone: LC 6 -4-0 3 z-O 3 Fax: ( ) Ice maker 12.51 , ❑ APPLICANT , ❑ CONTACT ;PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory / 25.02 2 , 4 5 7 0 2 _ City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan / 12.51 ( ./ ( E -mail: Urinal 25.02 Water closet / 25.02 - J , 02._ ' CONTRACTOR Water heater 37.52 Business name: / Water piping/DWV 56.29 Address: c Other: 25.02 City /State /ZIP: Subtotal (J, ( Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: • Plumbing Lic. no.: State surcharge (12% of permit fee) (0,0 Authorized signature: j ca „ @ / TOTAL PERMIT FEE 1 bg, (L . Print name: , ��� / � L �j�� Date: `71/2 04/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1.\Building\Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10 /02/COM/WEB) i Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: • Site Utilities Qty. Fee.(ea) .Total 'Square Footage: Permit Fee: . • Footing drain - 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 • Storm &Rain Drain - 1st 100' 62.54 Valuation:: Permit. Fee:' $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. • Fee • Total each additional $100.00 or fraction thereof, to h 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 ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. Quantity by (Fixture) Work. Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added ' Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi /Whirlpool Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser;Diagra>in • Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. -4 Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: 1:\ Building \Permits\PLMF - PermitApp.doc 2