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Permit CITY OF TIGARD MASTER PERMIT 2 COMMUNITY DEVELOPMENT Permit #: MST2010 00112 T A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2010 Parcel: 2S104CB04500 Jurisdiction: TIG Site address: 13468 SW ASCENSION DR Subdivision: Lot: Project: HILLSHIRE WOODS Project Description: Finish daylight basement. 8/18/10 added (1) gas fireplace and gas piping for fireplace B.T. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $35,000.00 Rear: 0 PLUMBING Sinks: 2 Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: 1 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: Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add! 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) HOLTE, STEVEN C & BARBRA J SHELBURNE DEVELOPMENT 13468 SW ASCENSION DR 7008 SW NYBERG RD TIGARD, OR 97223 TUALATIN, OR 97062 PHONE: PHONE: 503 - 692 -6383 FAX: 503 - 692 -5760 Total Fees: $1,397.17 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 . • ' ..t started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r -s adopted by e Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OA: • • - 001 -0100. You may obtain a copy of th- - •r direct qu- -tions to OUNC by calling 503.246.6699 or 1.800. 2.2344. • Issued By: _.../...---__ .�,' ' — - 'mil -f" Permittee Signature: ' . _ S :749:R4fig CITY OF TIGARD MASTER PERMIT A W 4 1, ` • 4 COMMUNITY DEVELOPMENT Permit #: MST2010 00112 r .. Date Issued: 07/13/2010 T E G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 sue ,; •;;.,;. Parcel: 2S104CB04500 Jurisdiction: TIG Site address: 13468 SW ASCENSION DR Subdivision: Lot: Project: HILLSHIRE WOODS Project Description: Finish daylight basement. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors. Yes Total: sf Value: $35,000.00 Rear: 0 PLUMBING Sinks: 2 Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: 1 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: Fum <100K: Vents: Woodstoves: Gas Outlets: Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 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) SHELBURNE DEVELOPMENT 7008 SW NYBERG RD TUALATIN, OR 97062 PHONE: PHONE: 503- 692 -6383 FAX: 503 -692 -5760 Total Fees: $1,343.93 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 ru - - • • •ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through • R 952- 001 -0106. You u -. • -_J•y of the rules or • -ct questions to OUNC by calling 503.246.6699 or 1.8 0.3 344. Issued :y: / -.-%// -�� Permittee Signature: • .s 'Aiding Permit Application FINED x pc t 7e 1 I2 -ES(, oeAirt Ato 3 0 -' I t>li 0I I Ic I utiE'.6NI N _ .. - _. *~ X - ' ' 4, r, Received City of Tigard DateB ALEifir Permit No/ttc l t7 ..0104,2_ 13125 SW Hall Blvd., Tigard, OR 9722 ITV OF T1GARD Plan Review t0 c Other Perm Phone: 503.639.4171 Fax: 503.598. WING r� lL a ST "COO 9 7 - 1 - 1,( � IJ IIVU DIVISION DateB �, � `R 1) Inspection Line: 503.639.4175 Date Ready : y: 7 � fin la See Page 2 for .? Internet: www.tigard - or.gov Notified/Method: ; / ti h f 15 Supplemental Information ' - ' TYPE -OF WORK )--`- • REQUIRED DATA : -1 A - ND 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: $ 35 000 e ix 1- and 2- family dwelling ❑ CommerciaUindustrial ) _ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: . • JOB SITE INFORMATION AND LOCATION • y� Total number of floors: Job site address: 13 Li 6 D Su) � 'en)5 I on) o k , New dwelling area: square feet City /State /ZIP: TI 6 A-120 , ' 0 12, ! 79-9-3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: HLTe_ Covered porch area: square feet Cross street/directions to job site: aeNc -Bute ) To AA tSTLe. - to . Deck area: square feet T O AS ye 5 10 /0 0 2 , Other structure area: 10 5 o square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: H-i ws►1t eze. w0005 I Lot no.: 7 r Permit fees* are based on the value of the work performed. f 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. F(NI so pLUMQIn1G , ei-eCTRtC4L . IA)Su riOA) Valuation: $ ,Mvo S keel phy y 6 kn 13ASeM 1 , Existing building area: square feet (l N 1 S I+ '-0 cam PL -r( on ) V New building area: square feet g• PROPERTY. OWNER . • TENANT • Number of stories: Name: 5T-e u.e1J 1 _ m ej3/42A do y-re_ Type of construction: Address:' 314 6 .U), As Ce l O/V 0 Q. Occupancy groups: City/State/ZIP: T ( 6 r ` NJ , 0 (C&.. 17 2-2-3 Existing: Phone: (5)3) s g3 67 Fax: ( ) New: ❑ APPLICANT ❑ 'CONTACT PERSON- NOTICE. , . ' , Business name: 514et_eli e_A, e _ Oeuel_opM,eaT_ - -- � 1,, II contractors and subcontractors are required to be Contact name: Te Ke kN 2e --- --( l (. _ li ensed with the Oregon Construction Contractors Board �7 der ORS 701 and may be required to be licensed in the Address: 700' SQ. NCI ace_ 6 0- 11 urisdiction in which work is being performed. If the City /State /ZIP: TUA 0e. 4'706 applicant is exempt from licensing, the following reasons �y / / apply: Phone: (563) 692— 6 3 �/ p 3 Fax:: (5O3) 6 [ 2. 57b 0 E -mail: j5he(A)Ze_P (V1 5f1). COM • _ CONTRACTOR Business name: Ske't. e °et) e-l.C)PNteAI BUILDING PERMIT FEES , Su), * . Address: 70 0 g S (.t), /� y (3 12 C. R d (P lease refer to fee schedule) . City /State /ZIP: -h, / }"r�4 Co 12 q ?06 Structural plan review fee (or deposit): 3 � , 6 t /l? 3) 677 6 3 .33' (503 6? 2 6 FLS plan review fee (if applicable): Phon • Fax: ) 0 CB lic.: ins Total fees due upon application: Amount received: �rio ` r 7 D Authorized signature: rit{ Li., / ,..1. , This permit application expires received: a permit is not obtained 6 /�� within 180 days after it has been accepted as complete. Print name: I � e 1 � Date: ( l (0 0 * Fee methodology set by Tri -County Building Industry 7 ,, rfn u Service Board. 1:\Building\Permits P -CO Pe itApp.doc 10/01/09 440- 4613T(1I /02/COM/WEB) Building Division Accessibility: Barrier Removal Improvement Plan REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation, alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per -cent (25 %). VALUATION: Total of all renovation „alteration or modification being done, excluding painting and wallpapering: [1] $ MULTIPLIER (25% barrier removal requirement): x .25 TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ (b) An accessible entrance: $ • (c) An accessible route to the altered area: ' $ - (d) At least one accessible restroom for each sex or a single unisex restroom: $ (e) Accessible telephones: $ (f) Accessible drinking fountains: and, • $ (g) When possible, additional accessible elements such as storage and alarms: $ TOTAL (shall equal line [2] of Valuation Computation): $ • • • I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08 . . .. Mechanical Permit Application , y0 R 01 l l c : l i s E N l . \ - Received = City of Tigard 4 ate (O ` C Permit No.: ' . ° 13125 SW Hall Blvd., Tigard, OR 97223 \� • �� Date/By: �/ Plan Review � Phone: 503.639.4171 Fax: 503.598.1960 �ta.) Other Pe 1 ' 1 � ��J � i lc A ii'1> Inspection Line: 503.639.4175 - Date Ready/By: H See Page 2 for Internet: www.tigard- or.gov 1 (' Notified/Method: , Supplemental Information n \� S • TYPE OF WORK • 1 .0.0. �1G�i1 COMME RCIAL FEE* SCHEDULE —.USE CHECKLIST r G` Mechanical permit fees* are based on the value of the work El New construction ❑ Addition/alteration/re l�ce� 01f performed. Indicate the value (rounded to the nearest dollar) of all • ❑ Demolition ❑ Other: �� jjUU" mechanical materials, equipment, labor, overhead, and profit. C ATEGORY 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 I Qty. I Ea. I Total . JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 1 3116 b Ste. cA s Ce_,vs , l --0/' . Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: Furnace 100,000 BTU (ducts /vents) 46.75 Fumace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: (-}_ U t„, r 1A �o. J Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 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 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances • ' DESCRIPTION ' :OF WORK Water heater 23.32 Gas fireplace V 33.39 33.3CJ _ t } ... ,„ I, we t place I p if Flue vent for water heater or gas t � fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 • ❑ PROPERTY OWNER • I ❑ TENANT • Chimney/liner/flue/vent _ 23.32 Name: Environmental exhaust and ventilation _ Address: Range hood/other kitchen equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ' ❑ :CONTACT :PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping Contact name: $14.15 for first four; 54.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax:: ( ) Water heater _ Fireplace 1 / y (S E -mail: Range CONTRACTOR ' Barbecue Business name: 6 SU>r� Clothes dryer (gas) Other: Address: 'MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal . Minimum permit fee ($90.00) LI 7, c Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 5 70 TOTAL PERMIT FEE 53„ 3- 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 I:\ Building \Permits1MEC- PermitApp.doc 10/01/09 440 -4617T (11 /02/COMIWEB) 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 oe1 /4. L- C'9t / e /2et(/ S Jun 29 2010 12 :54PMELBIELOPMEt9T 503 692 -5760 p, i Ch Electrical Permit Application „ ' i , ,I u 1 1 1 1 •1 t City of Tigard ®t _ oat /2 id - . 4 Permit No. fly 0 /Q -�� fig, II N 13125 SW Hall Blvd., Tigard, OR 97223 t � nn Plan Review Other Permit: '' Phone: 503.639.4171 Fax: 503 �9r. F Tl� Uamt1BY — ''' _ ` Fi w9vwli 503.639.4175 os ors 75BUILD DIVISION x d : 1m1, t l Infornatiao — ? �_ u ," :y t + •Y f'6'f'fb'4 tr'c '8 t y+ �..�.� F ! SS �� } �� ir :..a�K 'ca:= �ailiG., f's� '?.'�il ti 1 x± 4'14 !,M:1' t{ . n'if tlrrA . `:,,ii, . . 0 . please obeek alt tbat apply (submit &sets of plans whtems checked bolo !: ❑ New construction a Addllion/a1[erati0rt / t'e()1aCel ] leflt 0 Sa,ice or feeder 400 amps or more 0 Bu over three s - ties 0 Demolition 0 Other' sire the available fault current 0 M1wlnas and boatyards k .-! t>,r ,, *aN u-tx� x+ '�. . X.�4 .0 ,: ; ? C= exceeds 10.000 amps at 150 volts or 0 Plowina build ng'i r';... i' s 'fit k' ;d u i I ,� 7 _ v ,. . �s r�', •-, r '(tk _�.' ��51s'Sivliars��� v�..?� - x'� _ - . less to ground or exceeds 14,000 ❑ Comroeteie! -.1.4 agmtdhn =.i I - and 2- family dwelling 0 Commercialiindustrial 0 Accessory building maps for all other instillations buildings. i ❑Multi-family 0 Master budder ❑Other 0 Fire pump. 0 installation of 75 },�. A or Sire..... ' , �1r'" • "` '++x - ;t 0FJRBIBe11LV system. �ar(pY separately det'.•Cd r•:tem a.5 ' al 5.' i ° 7 t , a 1 g 1 � ' f ' ' 31 � po _ k - - ,v : , _. :r . ..,tss:r d n it ..+?r4.�Ylw::�"ucta. � "i. -`- 0 Addition of new mntmr land of ❑' - . - 100HPor OCCIVVICy Job no.: fob si addres I3H 6 Ff 5 (A) A5eer 1 0N b2, 0 S ic or more residential twit., ❑ Recreations' .eh!cic ear c• 7 � � 0 Health -care facilities. 0 Supply •oltaco rur•. , rtrc t .} City/State/23P: - 1 - 1 � k 0 Hazardous locations. 699 volts roman! Suite/bldg./apt no.: 0 Service or feeder 609 amps or testis ,: Project name: (Lire 1 , ats;__ = _„neck ..:; y «�. ;:. ° :: ; ;. r. .- _,. P(J Cross street/directions to job site: �C.(•4UL - to /vt LS ILev a .' 1 Fee. I Total - New residential single- or multi- family dwelling unit. I D / t CeN S I O N ye-. Includes attached garage. _ -- Subdivision: R ( L.(,s1t 2-e t,,Joo■DS I Lot no.: / I 1,000 sq. ft. or less _ 1 16S. 5-1 Ea. add'I 500 sq. ft. or portion 33.9: I : Tax map /parcel no.: Limited energy, residential 67.8 - v, �,, .. ,.. :.... G.., � ,= m. - -4; ;:_tti ; sr5 ",..,s?igt:i. - : (wish t . , m tt.) -- "�'iJefi-ast-}. - P ., r ., Gv:'zi':•: �fC p Amp ' C f' 34 1 Limited en multi- family 67. y AC ("4- W I R€ F'"�N tLS CT P/�Y(-4CA}I- residential (with above sq. ft.) , - -- _ . 1� C Strvices or feeders Installation, alteration, and/or relocatiult ArseNA rt.)T To co PLxriOA) 200 amps or less 100.70 , - st• �_, �?:<>� = �:s� - ',rs " � '�• :` ;`::a: 201 amps to 400 amps 133.56 401 amps to 600 amps 200 34 Name: $j-et) ± 110 LTC _ 601 amps to 1 amps 301.03 -- -- Address: 13 L6' S: cal) - 5Cec s (pa) p12. Over 1.000 amps or volts 552.2r' ±: City/State/ZIP: Ti ( Temporary services or feeders instaltalion, alteration, ants: or 7 223 relocation — - ' Phone: 6-0 3) 57 � 6 i Fax: ( ) 200 amps or leas 593.: 201 amps to 400 amps 25 0-` _ Owner installation: is installation is being made on property that 1 own which is not 401 599 i 25 sr _ — intended for sale, )ease, rent, or exchange, according to ORS 447, 449, 670, and 701. circuits _new, alteratio4, or extension. per panel _ Owner signature: Date: R. Fee for branch circuits with 1 ✓� � }� t ,14-';,,,M,... fir, e,y , f abate service re feeder fee. 7 :%>�:;hr .; w ?i_s .. . I each branch circuit Business name � 'e L t5 ) °. ev eLcYe ntie N ( B . Fee for branch circuits without S service or feeder fee, first ) 56 i 3 < �/ Contact name: �C N e l N Ze b circuit • „ - _ /2 ,/� /� Each add"l branch circuit 7.4'1 ra 4 Address: -7 c �. - () N'f ra�6 o Miscellaneous (service or feeder not Included) r • L 7 Each manufactured or modular 67 4 Ciry /5tateiZ�': 11 N 0 / `� 2 dwelling, service and/er feeds Phone: (5'63) 69'Z - 3 25 3 I Fax:: (9)3) 6 C ? C 7 go Recomtect only 67.44 - -- " Pump or irrigation circle 67.34 E -mail: 914e (/J :� (14-, e CO nil Signor outline lighting 67. '", :• c• a;: : "lr±t: s; s a.Y + fit ?5 r '. 3-< L *:4.1 Signal or '%..: : . t`:a _ •' -„... , 0( •• Y , ' x, ui ,:a-, 10, ` 241“ TT r 16 s 2 v tt '.: Sil =cu ids) o limited-energy r Business name: /�� f(t�J� _ panel, alteration, or extension. Page Pate '- � Each additional inspection over allowable in any of the above Address: * 0 - j »1 �.N . - Additional inspection (1 hr min) 1 66.2.5! hr 1 - T FP II - Inreshgairon(lhrmin) 66.1 "hr - - t j City/State/ZIP: rs. • x- hr �� y7� /'y q Industrial plan (1 h von _ _ P ,.. e: 0 ; ' _ ,. J I �� eY I (� Inspections for which no fee is ~ 90 01.! hr i lJ � �- 5.. ific,al listed hr min CB Lic.• i" �� • ectrical L ic • f r%v Lic.: ) i,. 7 R -- za1 r;�-,1' ,:`. y ,-'-.s ` f 7 �/�J7 J ,--- e ' Subtotal ' ` a �j Supty. Electrician signature, required a e� , , ,. r.,-.4, - Plan review (25% of permit fee): _ _ Print name: C11 (1(' , ' _- G a � r t t x � i ' Date: - State surcharge (12 %of permit feel: i II ' r - - VV TOTAL PERMIT FEE: j 17\ .L A-2 Authorized signature: Tins permit application expires if a permit is not obtained wilt tat lrte days after It has been accepted as curt plate Print name: Date: • Number of inspection allowed per permit ■ I BciIdingwtm,itrur.1- ParsnAppdos 10,01109 440,16t4T(11 /05/ O /W® � � Mechanical Permit Application ��V�iD � r °Y OR,), l lc 1 l,til m Received City of Tigard Date /By: c � By: `'' d 0 tla.r Permtt —�_/ / �otl//� U N " ipl q 13125 SW Hall Blvd., Tigard, OR 97223 rs 0 7 31O Plan Review '' `` IS • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: I I G A It I> Inspection Line: 503.639.4175 TIG k RD Date Ready/By: to See Page 2 for -' Internet: www.tigard- or.gov CIS ®F DWI, Notified/Method: imj Supplemental Information BUILDING D 1 • 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 1 Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION • Heating/cooling Job site address: 1 ?j't-f 6 2 5 (4) AS C -('N 1 CJ t\/ 2 2 Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: 'r ( 6 /--P---19 0 (Z 9 2 �3 Fumace 100,000 BTU (ducts/vents) 46.75 / Fumace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: 1:11 e Heat pump 61.06 Cross street/directions to job site: ^/ ( — ,. j 1, -e.,) fiO (IA 151 E_rtcx Duct work 23.32 1 , J ` � S ( Q �/ n 12 R n t hot water system 23.32 l Residential enti al boiler r (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 L L Lot no.: �j Flue /vent for any of above 23.32 Subdivision: If 5 �+ O 5 / Other: 23.32 Tax map /parcel no.: Other fuel appliances • DESCRIPTION OF WORK • ' Water heater 23.32 `' � / Gas fireplace 33.39 V /�/� ( - . t 1 t ' Q t /) Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 • Wood fireplace /insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 �a Other: _ 23.32 •3 - � - ' e Name: 1 V ,' --e_(-i} t \ NO L- a Environmental exhaust and ventilation 3 4 6 5� Address: kA t1 C f /V 5.1 (J 42 P I Range hood/other kitchen equipment 33.39 City /State /ZIP: — f (6 /A 0 cl 7 2'13 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: T - 0 ) -7C( - ."3 6 7 Fax: ( ) toilet compartments, utility rooms) I 23.32 ,32— / E5I APPLICANT - • ❑ CONTACT PERSON. . Attic /crawlspace fans 23.32 • Business name: l t C LR Lk (Zr l e V€ v Q L U Pe AA_ C''A Other: 23.32 Fuel piping Contact name: , ) e 14'4 ((\i 2 e-- $14.15 for first four; 54.03 for each additional Address: 706 ,0 Arl Ge>R4 R p_ Fumace, etc. Gas heat pump _ City /State /ZIP: 1 LtAI-AT(A) 0 9 70 (j 2_ Wall/suspended/unit heater Phone: (.S(�3 ) 692--‘g � 3 ' Fax: : 1— 6q2 S76 0 . Water heater Fireplace E -mail: j S I E. t J Z P_ @ M SA/ . Co A4 Range • CONTRACTOR • . • . Barbecue Business name: r yR tm ( i (E� V T(,J6 - Coo —1 N G Clothes dryer (gas) 1 Other: Address: ea no, I Sa MECHANICAL PERMIT FEES* . City /State /ZIP: S I Ui� 7"7055— Subtotal 22, h� ,r0 3) 7`S 6 c7 S i. . ! Fax: ( )- Minimum permit fee ($90.00) 14-, 4 Phone: ( 2 5 ) : ' �3N 3_ Plan review (25% of permit fee) CCB lic.: State surcharge (12 % ofpermit fee) (j), ,C) TOTAL PERMIT FEE 1. co 8C) This permit application expires if a permit is not obtained within 180 Authorized signature: , days after it has been accepted as complete. Print name: ` 4_ li -c' l A/ 2C Date: 6 /3 0 7/0 * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \PermitsVMEC- PermitApp.doc 10/01/09 440 -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 Plumbing Permit Applic irE1VED Building Fixtures 1 FOR O 11 I t 1 1� ti1 O vI , City of Tigard JUN u 0 2-010 DateB ,s.d /d J Permit No./1 ,;20/0 �60//:2_, a 13125 SW Hall Blvd., Tigard, OR 97223 TIGaR� Plan Review ' Ill ;''i Phone: 503.639.4171 Fax: 5effill `).'l DateBy: Other Permit No.: 1 . Iection Line: 503.639.4 At DIVISIO 1 . I ;,\-l< I nsp $U Date Ready/By: orris: Fa See Page 2 for Internet: www.tigard or.g Notified/Method: Supplemental Information TYPE OF WORK i ,FEE* SCHEDULE - . ' ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. Ea. 1 Total A ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION ‘ SFR (1) bath 312.70 tst I- and 2- family dwelling ID 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. SIITE INFORMATION AND LOCATION . Site utilities: Job site address: 13416 51 ,'S ceN 5 (d /) Oz. Catch basin or area drain 18.76 City /State /ZIP: 6 k � I O � t ' � 2- Fo leach line, linear r ft.: drain 18.76 e 2 . - ``_ 6 _ Footing drain (no. linear ft.: _) Page Suite/bidg. /apt. no.: I Project name: 11-0 UTE Manufactured home utilities 50.03 Cross street/directions to job site: 13 CtOcii.0 (.Q) TO p4 tsm 'toe. Manholes 18.76 «N5( d Ai t Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: _1 Page 2 Water service (no. linear ft.: Page 2 Subdivision: I-1-(1-1,S11-( I. WOO bS I Lot no.: 71 Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WO . Backwater valve ( 12.51 (2. 54 Clothes washer 25.02 FAU LS If P G e-Lec-T21 cq-L_ � 4444S t,t, 1d AJ Dishwasher. 25.02 ,4 N 0 5 Lf eeTrLo C IC-- !AY0 04 ISASC k N r, Drinking fountain 25.02 F(N l S H TO CO M PLe t 1 C) N Ejectors /sump 1 25.02 25, 02_ PROPERTY OWNER I' ❑ TENANT Expansion tank 12.51 Name: , s -re UeA) '- a j 6 A }- O L -T� Fixture /sewer cap 25.02 Address: (3 6 ' 5W J pN (o iJ D (� Floor drain floor sink/hub 25.02 �/ Garbage disposal 25.02 City /State /ZIP: Ti C k ! 0 ! n V r` i-2 3 Hose bib 25.02 Phone: cSo3i 5 7i 8"3 6 7 Fax: ( ) Ice maker 12.51 ,J . APPLICANT'. , . ` ❑, CONTACT PERSON . , Interceptor /grease trap 25.02 Business name: S Re(_414RA) e V +e V e_(.p P /� • . An-- Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: H 2-c._ e tN 2-c._ Roof drain (commercial) 12.51 Address: 700 g 5(A), pj'f L3e(_G 12.9 , Sink/basin/lavatory 7 . 25.02 5 City /State /ZIP: 1tAt r -r-( A/ ) © 7 70 6 2 Solar units (potable water) 62.54 Phone: (3 ) 6' 63 533 rFax:: (503) 692- S76 0 Tub /shower /shower pan I 12.51 12_ ,'51 Urinal 25.02 E -mail: J S IA etA)Ze M 5 n, t._0 Nt. . Water closet 1 25.02 - 2....,c) C CONTRACTOR Water heater 37.52 Business name: A) Cµ .f 1 M GI N(> Water piping/DWV 56.29 Address: I c( 3 0 S _ 1 r -2 a S o Al KO. Other: 25.02 City /State /ZIP:0I2�G0tJ CAT `-/ Q 97095 - Subtotal �OZ�j,l �` Ph e: (503) 7g ' - 3C 13 Fax: 3 ) 6 3- 77 7 z Minimum permit fee: $72.50 CB Lic.: 163 7 - 7(, umbing Lic. no.: 3'- Li 2S/ P� Plan review (25% of permit fee) State surcharge (12% of permit fee) (#j. Q ' Authorized signature: , ' u. t TOTAL PERMIT FEE f A Q 1 Print name: /� j�, Date: 6 / p / i b This permit application expires if a permit is not obtained with [ 0 days M �R A. 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 • - ; 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 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 Other'Ins ections.;orTees Qty. . Fee(ea) : ,,Total each additional $100.00 or fraction thereof, to p 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 Tub /S ❑ New exterior plumbing site utilities for any complex structure Bath - hower Tub /S ower rlpool . as defined in OAR918- 780 -0040. . Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. ` • Cuspidor/Water Aspirator 0 Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial - Domestic Submit 2 sets plans with any o f of above. Drinking Fountain Eye Wash ' .. Isometrie or Diagram ... - Floor Drain/sink - 2" . , ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. 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