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Permit 104- /10 Re pro M pefI C--kaa-e-4 CIS -Eaef- 1- (c rc..c,:- a CITY OF TIGARD MASTER PERMIT ' 0 COMMUNITY DEVELOPMENT Permit #: MST2010 -00113 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010 Parcel: 2S110BA02000 Jurisdiction: Tigard Site address: 11830 SW GAARDE ST Subdivision: Lot: 0 Project: Gotter Project Description: 40 SF addition. 7/28/10, adding (2) lays, (1) shower pan and (1) water closet. 10/5/10, additional electrical. 10/13/10: additional electrical to bring the total to (1) 200 amp service; (1) 200 amp feeder and (25) branch circuits per Gary Noble. DLH. 10/27/10 adde (1) feeder and (3) branch BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 2 0 -200 amp: 0 W/ Svc or Fdr: 25 Ea add'I 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'I 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 Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) GOITER, SAM OWNER 10125 SW MURDOCK TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $2,577.96 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 Notif'cation Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a • • •y o 1 e • - . •r direct questions to OUNC by callin 50 .246.6699 or 1.800.332.2344. Issued By L_��iL.: _ 0 � Permittee Signature: 1. �i�l'✓U .1ClA /% P &) ..0 ,...-gale.,2 . a CITY OF TIGARD MASTER PERMIT .1111 e.'.. COMMUNITY DEVELOPMENT Permit #: MST2010 00113 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010 Parcel: 2S110BA02000 Jurisdiction: Tigard Site address: 11830 SW GAARDE ST Subdivision: Lot: 0 Project: Gotter Project Description: 40 SF addition. 7/28/10, adding (2) lays, (1) shower pan and (1) water closet. 10/5/10, additional electrical. BUILDING Floor Areas Required Setbacks Required Stones: 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add' 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 add9 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) GOTTER, SAM OWNER 10125 SW MURDOCK TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $2,296.59 This pe ' is issued su ' , to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be ne 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 ys. ATTENTION: Oregon law v • . es you to follow the rules adopted by the Oregon Utility Notification Center. Tho - rules are Set forth in OAR o 952 - 001 -0010 through OAR 952 - -0100. Yo • -y obtain a copy of the rules or direct questions to OUNC by calling 503.246/99 or 1.; 10. 2 • ; Issued By: fj Permittee SiSnature: / • (13 t I.N CITY F -lGAR® MASTER PERMIT ` COMMUNITY DEVELOPMENT P ermit #: MST2010 00113 4.f Date Issued: 07/14/2010 4.1G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 - a. . Parcel: 2S110BA02000 Jurisdiction: Tigard Site address: 11830 SW GAARDE ST Subdivision: Lot: 0 Project: Goiter Project Description: 40 SF addition. 7/28/10, adding (2) lays, (1) shower pan and (1) water closet. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 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'I 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) GOITER, SAM OWNER 10125 SW MURDOCK TIGARD, OR 97224 PHONE: PHONE: FAX: • Total Fees: $2,069.83 permit is issued ect 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 proved 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 la • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 - 001 - 0010 hrough OAR 952 0100. Yo y obtain a copy of the rules or direct questions to OUNC by calling / 503.246.6699 or 1.800.332.2344. sued By: / / Permittee Signature: o CITY OF TIGARD MASTER PERMIT Is :: COMMUNITY DEVELOPMENT Permit #: MST2010 00113 T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010 Parcel: 2S110BA02000 Jurisdiction: Tigard Site address: 11830 SW GAARDE ST Subdivision: Lot: 0 Project: Goiter Project Description: 40 SF addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addl 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) GOITER, SAM OWNER 10125 SW MURDOCK TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $1,881.75 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 ' - - - - •• - nce 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. ENTION: • =gon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos= rules are set forth in OAR 952-L11-0010 through OA' ' • -001 -' 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 '00 3 / / , . Issue By: «�� -d _ Permittee Signature: / , 415.'liline Permit Application Residential 01:1:1(1; IJSF:ONLY D �� City of Tigard D DateiR ar. i Permit No.: tip ,fir "— ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • II : C Phone: 503.639.4171 Fax: 503.598.19 , . j ,-- , ' Date/By: L I' . � j I O Other Permit: I'IGAK Inspection Line: 503.639.4175 Date Ready/By: Juris: ® g Se Page 2 for Internet: www.tigard- or.gov Jth� 1 2010 D R Date ead/B t I() , Supplemental Information 14 TYPE OF WORK0V Q 1iL,��tt,�f7t`1 REQUIRED DATA: 1- AND 2- FAMILY DWELLING • ❑ New construction ❑ Dgdl tmni `t� I,' r 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. pill- and 2- family dwelling El Commercial /industrial Valuation: S -t 0: 00 Number of bedrooms: 11 Accessory building ❑ Multi- family 0 ❑ Master builder ❑ Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: I Job site address: i% 83 0 .) Cam► uG r� SA . New dwelling area: Liu 0 square feet City/State /ZIP: T (� �� 6(1- s---) a a, y Garage /carport area: o square feet Suite/bldg. /apt. no.: b I Project name: 6 Covered porch area: e square feet Cross street/directions to job site: S-t.3 P c, C-.e._ Deck area: 8 square feet Other structure area: 0 square feet 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.: I 13 A n,.x0 00 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ® RF SOU Q W S 4LL ,Idn F-LOC' 0 ADCs On/ Valuation: $ Existing building area: square feet AAA `i TO A P 0 A f ` ;liar.) New building area: square feet ar PROPERTY OWNER ❑ TENANT • Number of stories: • Name: ^ � 7 G __,,- Type of construction: Address: j,0 / 2S ) i....4,,,-8 Occupancy groups: City/State/ZIP: 'T'1 , _,,L CR c ( 7 ;-.9- / Existing: Phone: (l3 (03 Co lv 9 Fax: (5-03 )(035, - O (0(05 New: a 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: / a /a, j ,s,--t,3 t•-4 L, ( A . _ - jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/ State/ZIP` r L 0 Z S - 7 a LI apply: Phone: (Sb1) G J ` - y z ^ t w o c 1 ` Fax: L, loJ E -mail: a y' 0 a bra V t� Gr't c • C_ o- -- _, r CONTfiACTOR Business name: If Clq,A/1JCir BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State /ZIP: Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) ....../ CCB lic.: Total fees due upon application: �7� / ii Amount received: Authorized signature: s q It1 Go Trcit This permit application ex i ion f a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: - yi /lam * Fee methodology set by Tri- County Building Industry SelevA ,I --C ,*-e,- IR- Service Board. I:\Building Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB) 1 . cal Permit Application City of Tigard .. • 13125 SW Hall Blvd., Tigard, OR 97223 1 2 - , F,Lik_,('0. i'','1' Irn , • :. .ved '1 IL:.,,„•!:'. -."' . -'. 1 ZOO Plan Review , Phone: 503.639.4171 Fax: 503.598.1960 JUL 1 l Date/By: , - . -) In.spection Line: 503.639.4175 IR, Inte AFI / / rnet: .tigardr.gov YAM -o Date Ready/By: cify ef : TiciAB4Notified/Method: IA /R 111.1.1( I I ■I. tr\ 1, \ DatelBy: Permit No.: Other Permit: !aria: 121 See Page 2 for Supplemental Information TYPE OF WORK ci. 1 Ut CMG: DIVISION PLAN REVIEW 0 New construction Ur Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground, or exceeds 14,000 0 Commercial-use agricultural Et 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 75 KVA or 7 0 Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION 0 Addition of new motor load of 100HP or more. occupancy. Job no.: Job site address: /, 83 0 31.3 G ,,..., , ck...... 54 . 0 Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: 'Ti , ,...A rj 9' - 7,1 c) Li a Health-care facilities. 0 Supply voltage for more than 61- ci Hazsrdous locations. 600 volts nominal. Suite/bldg./apt. no.: I Project name: CIService or feeder 600 amps or more. - th. D I Cross street/directions to job site: S.4.,,_, 1 19 v 1 c ca. Desaiption FEE SCHEDULE 1 Qty. 1 Fee. 1 Total 1 • New residential single- or multi-family dwelling unit. Includes attached garage. 1,000 sq. ft. or less - 4 Subdivision: Lot no.: Ea. addi 500 sq. ft. or portion 3192 - 1 Tax map/parcel no.: ,.. 5 1 1 0 3, A 0.2 coo, Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi-family 67.84 2 R t- W 4 4E- PA) ERY rei ..%1 w i- CA r•I lk 1 ti-cri residential (with above sq. ft.) Services or feeders installation and/or relocation t LUGS 54.'1 ICriE. S (1S st . - ei- 200 amps or less 100.70 2 or PROPERTY OWNER I TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: SA-en &e E, R 601 amps to 1,000 amps . 301.04 2 Address: i 0 I a. S . 5" - tx) t olt 0 OC il S-1- Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: 7 - 1 c „,,, t . A 0 , 0 k q 7 2 ii relocation Phone: (.11)3) '. 3 g -lig 6 q 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 I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel 4 Owner signature: Date: A. Fee for branch circuits with APPLICANT 1 0 CONTACT PERSON above service or feeder fee, each branch circuit 7.42 2 Business name: , B. Fee for branch circuits without ■ 00 service or feeder fee, first ile) Contact name: ,- r.,.%.--1,--, Goo--\-\„- branch circuit 56.18 2 kl) Each addi branch circuit 7.42 2 /1/4A I Address: /0 1 a „s-,..,,) ,,, „-cki,,,,L '- Miscellaneous (service or feeder not included) _ eft, _ Each manufactured or modular # City/State/ZIP: -- Ti . & ora_ 9 7,4 .2 (4 dwelling, service and/or feeder 67.84 2 (3 - Reconnect only 67.84 2 - ' Phone: ) (039 c I 3 lac) Fax: : (skai ) ( 7 _ (:, (4 , ( ,...s - Pump or irrigation circle 67.84 2 . E V1A \ 0 °AC 4 Ni 4\ 0. C0 t,1, Sign or outline lighting 67.84 2 CONtRACTOR Signal circuit(s) or limited-energy panel, alteration, or extension. .... f Page2fi 1 5 " : clj Business name: S vv s EL ec_ . Address: e A/ e,s PA r 1.A City/State/ZIP: 54, 1 ! i voy . 0 (D ci 7 /.2 4 Investigation (1 hr Each additional inspection over allowable in an the above Additional inspection (1 hr min) tnin) 66. / hr 66.25/ hr Industrial plant (1 hr min) 78.18/ Iv 4.., Phone: (.5-0) )8 _ 5 7 , 3 Fax: ( ) 7.61‘,50, Inspections for which no fee is 90.00/ lv -1` specifically listed (% hr min) CCB Lic.: /0 Electrical Lic.: .3 - 77c, Sup Lic.: x2 _ /c ELECTRICAL PERMIT FEES ... r Suprv. ElectriVUture, required: : . ' Subtotal: . .37.01‘11 9 ,572, ..:. 4 r y . . Plan review (25% of permit fee): Q Print name: arlfr,aoitte!) • ate: State surcharge (12% of permit fee): „ ple's TOTAL PERMIT FEE: 1 „Fir,ci e Authorized signature: This permit application expires if a permit is not obtalted within 180 days after it has been accepted as complete. Print name: 5 - r - AN, 401i\ Date: 4 /5 0 j , , • Number of inspections allowed per penult. I: \Building \ Permits1ELC-PermitApp dor 10/01/09 440-4615T(11/05/COMAVEB Plumbing Permit Application � '. ' �� • Bu G �f • tl)'' ? •:f • Sr4 Building Fixtures F +.. + •� „ z . ` 9 r d ' „ .::. T F fir,, l OIZ °t �., ' 1 . l µ '� : i t tgi ;, f City of Tigard Received Permit No 00 a 13125 SW Hall Blvd., Tigard, OR 972 1L 15 2010 Date/By: �O� I 1_3 '� 0 Plan Review ; Ph one: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.: l' I (; AR I Inspection Line: 503.639.4175 CI Ty OF i 1 A D Date Ready/By: Juris: 10 See Page 2 for Internet: www.tigard - or.gov pull no h lf' l..r%l. /IC -Irv. Notified/Method: Supplemental Information e� s� . v I�,ttsea FEE* SCHEDULE TYPE OF WORK ❑ 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 0 Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: i 1 g30 SI,¢J C--,MA R azt 0 \ Cat. basin or area drain 18.76 ' 1 C it ` • r leach line, or trench drain 18.76 City /State /ZIP: d ooting drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: �� Manholes 18.76 7//CMCI\ Rain drain connector 18.76 A t Sanitary sewer (no. linear ft.: ) Page 2 U Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I , [/ Fixture or item: Tax map /parcel no.: , 0 Backflow preventer 31.27 DESCRIPTION OF WORK - Backwater valve 12.5 l Clothes washer 25.02 C _ •. - gi 7 _. ../ R Dishwasher 25.02 •iraar`- ... '+ ---. -• •ta'�� +"• :-'° }?A Drinking fountain 25.02 � :. � J� e{ -f a - ; / Ejectors/sump 25.02 f' WO �Ool Tv ,,, /34.:(1.4 J P ❑ PROPERTY OWNER -TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 S �° fYl G G� d`Y� Floor drain/floor sink/hub 25.02 Address: /0 f S S o r i'31 0 � 1 t ) C(_ $ i Garbage disposal 25.02 City /State /ZIP: 77 b A-141...4 P Hose bib 25.02 Phone: 03 ) 93. b--7j 1 '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 d2 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /showeii'ower pan-) i 12.51 E -mail: Urinal 25.02 Water closet Y 25.02 'CONTRACTOR . 1 4 C Water heater 37.52 Business name: 0 t� N Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: 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) 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 - 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 (ea) 'Total each additional $100.00 or fraction thereof, to 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 -Tub/Shower 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. CuspidorfWater 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 Isometrics or Riser Diagram . 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 aid before the Washer - Clothes p Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: I:\Building\Petmits\PLMF- PermitApp.doc 2 Mechanical Permit Application - . F (11.1 :1( 1.SI: ONE_, City of Tigard g r i=. y , Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 ;li ' plan Ike ew C ` Phone: 503.639.4171 Fax: 503.598.1960 Date/B Other Permit: TIGARD Inspection Line: 503.639.4175 1 1 I I O �e Read luris: ® See Page 2 for Internet: www.tigard - or.gov tif ied/Method: Supplemental Information CITY CF TIGARD TYPE OF WORK BUILD N DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST E Mechanical permit fees* are based on the value of the work El New construction ® Addition / alteration /replac CtSiti 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* 51 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 „,,...A._ S Aiq fires s to pl ng Job site address: / / 8 3 0 showing p . �,, (requires site plan showin placement) 46.75 _ City/State/ZIP: t _ 9 tea, a LI Furnace 100,000 BTU (ducts/vents) 1 46.75 �,775 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: ,j i 1 9 P 1 c R Duct work 1 23.32 J.??Z Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), m -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.: . S 1 0' A O a 0 0 c p Other fuel appliances DESCRIPTION OF WORK Water heater • ( 23.32 2 - ll \ c \ Gas fireplace 33.39 / h S \ \c� t� 4N � & h e-,-.3 e\�c % c- J' �c. Flue vent for water heater or gas 11 fireplace 23.32 c.....--•.&.. �`'."4e- "` Log lighter (gas) 23.32 4 1`; -„ L'i f,0 r k s) . Wood/pellet stove 33.39 Wood fireplace /insert 23.32 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: c. `,.,.‘ C 0"CT',....r. Environmental exhaust and ventilation Address: / a�— c3� t].c�� Range hood/other kitchen / t /' equipment 33.39 City/State/ZIP: i `� ,k_ c .5--a_ 9 -7 .?-3-4-1 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (673) (0 3 5 - y8 (a 5 Fax: ( - 5 Z A ) (037 — 0 Cv (e 5— toilet compartments, utility rooms) 23.32 rii APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping Contact name: ��,..‘ z r _ 514.15 for first four; 54.03 for each additional Address: j o I a. , D µ Lk r c... ' Furnace, etc. Gas heat pump City/State /ZIP: N_ 6 , L 0"Z c - a a ti Wall /suspended/unit heater • Phone: (SDI ) (, 3 5 4 Fax: : () (0 O(v 47 Fireplace heater `` Fireplace E- mail:' o`'u 0,3_, C1¢ c� W . c_-, Range 71 CON RACTOR Barbecue Business name: -t-eG /c4 r Clothes dryer (gas) Other: Address: o.p a 33 MECHANICAL PERMIT FEES* City/State/ZIP: 6.3 a&O Urv - \ c3\., 5- Subtotal el ? Minimum permit fee ($90.00) Phone: (sin) 5 807 - S 5,9 Fax: ( ) Plan review (25% of permit fee) CCB Iic.: ( 03(0c2 1 7 1 /1 )- State surcharge (12% of permit fee) 1 , 'Z ( ,..11‘4: -- .`e.--- --- / TOTAL PERMIT FEE11O , 4 Authorized signature: This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. Print name: Sew„ (-j7 I Date: %o//O • Fee methodology set by Tri-County Building Industry Service Board 1: \ Building \Pennits\MEC- PennitApp.doc 10/01/09 440-4617T (1 1 /02/COM/WEB) 1'linnbing Permit Application q Building Fixtures F FoR OFFICE li l: l)N'1.V .. e' � 1N I i R ecei Date/By: ved City of Tigard '�' C PermitNo.: go \ O II 13125 SW HaII Blvd., Tigard, OR 972 ` , `" Q, C + Plan Review Phone: 503.639.4171 Fax: 503.598.1 Oa `` 1 �B y Other Permit No.: T i G A R D Inspection Line: 503.639.4175 \- n� s ate Ready/By: kris: Id See Page 2 for . Internet: www.tigard- or.gov ` - c\ t r r. ill , tified/Method: Supplemental Information TYPE OF WORK G� a �1�V FEE* SCHEDULE ❑ New construction ❑ De mo t` 'V For special information use checklist Description 1 Qty. 1 Ea. 1 Total PI Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 54 I- and 2- family dwelling ❑ Comercial /industrial SFR (2) bath 437.78 m ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 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: / / 830 3 GG,, Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State/ZIP: - T' 6 ,, --62 9 - a 2 4.-1 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03 Cross street/directions to job site: 54_,3 ( 19441 V 1 elC�- Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ____) Page 2 Water service (no. linear ft.: _) _ Page 2 _ Subdivision: �1 I Lot no.: Fixture or item: Tax map /parcel no.: a J 1 i o a3 A- 0„1000 Backflow preventer I 31.27 I DESCRIPTION OF WORK Backwater valve 12.51 l - Clothes washer 25.02 l h 5t�k` tne� W `iT1 " _ � t ea ; Dishwasher 1 25.02 2 6 - .02- Drinking fountain 25.02 Ejectors /sump 25.02 RI PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: .1.A -• � - Nvt o Floor drain/floor sink/hub 25.02 Address: ,Nr l ( / � t c r [ Garbage disposal i 25.02 , �, Q67....- City/State/ZIP: Q 2 ?..1... r 7 Hose bib 25.02 Phone: (61)1) 4/15 (,9 Fax: (V,)(,39 - 0 (✓ Ice maker 12.51 ist APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Contact name: ` G Primer 12.51 c�‘ `) Roof drain (commercial) 12.51 Address: / c7 / D S ` ,,J I.4 ,,,,,I, J, Sink/basin/lavatory 1 25.02 234 OZ.- City/State/ZIP : - r k 071._ c5 -7 a y Solar units (potable water) 62.54 Phone: (3 ) to 3V _ y 81/4 Fax: : (Sul ) ( _ O(oG,s- Tub /shower /shower pan 12.51 ` Urinal I 25.02 E -mail: oi 4t Ocae, (i2 0 T cn� 0-0 . C-0-1.-..-, CON RACTOR Water closet 25.02 ` Water heater 37.52, Z 52- Business name: �. - oy rr II * ? r �w.kot „� Water piping/DWV 56.29 6t,Zel c to U / Address: ? 0 li- x / 9 ,---8 Other: 25.02 City/State /ZIP: Apr ? 1c O ci 7 / 53 Subtotal / 1 P.0 1 j Phone: (5 3 o5 - S7 j ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: /512 i 3 c. Plumbing Lic. no.: 3y - KOa P b Plan review (25% of permit fee) � � State surcharge (12% of permit fee) ('/ 0G Authorized signature: TOTAL PERMIT FEE 'eq. Print name: S � Cep 1 1 Date: VIA Q 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. I:\ Building \Permits\PLMU- PmnitApp.doc 10/01/09 440-4616T(l0 /02/COM/WEB) Electrical Permit Application r r , E.\\1 ED FOR OFFICL: (ISE ON1.1 1, ° 9 City of Tigard r..■.) ),..c.;aivc4 , 1 M 1 • _- Data : Permit No.: o i - 00 i / .3. 13125 SW Hall Blvd., Tigard, OR Plan Review ' 0 _ • Phone; 503.639.4171 Fax; 503.598.196bc1 VI t/ Date/By: Other Pennit: — TIGAKD 0 r Inspection Line; 503,639.4175 Date Ready/By: _ Aut.• see rage 2 fo Internet: www.tigard-or.gov r . 61 40 Notified/method: , Suppkatental Information ....'" ..-;.; .'" '',iii,ir it&ibk.:•:::".••• . ...::: - -. ; • -: . 0 New construction please cheek all that apply (submit a sets of plans w/mons checked below): 4ddition/alle Placement 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current CI Marinas and boatyards. .... • :.,. • ; ..: !,„: . :::;: •;', iaeNg'iliuctir N ••••••;:..,•'; :;:....1.;: : i.•:• , :l..... i. , : . .....:,:, - .:,.. exceeds 10,000 amps at 150 volts or 0 Floating buitclings. .• : • .. •'.: ........." ...• • , ••'.:.: , :':.':.. : ...1.:." , • - • 4 71r , 7 •••,, ..":•.• • - • • . • . - !' ;':•' ' '' ''' '-'; less to grouncl, or exceeds 14,000 1:1Commacial•use agricultural 0 1- and 2-family dwelling 0 Commercial/industrial ,Accessory building amps for all Wan installations. buildings. El Multi-family [21 Master builder 0 Other 'prim Imo, CI installation a 75 KVA or . . . 0 Emergency system larger separately derived system. 0*:"§iii: iisfkiitiOciefiTa:itmJ4,(k,..4iiiigi.:'.:;i:; : .::' :'.::..i.1!;::;;;; ::" DA44rnonofnewrnOt�toadOt 0A E" '12 1 3'• 100HP or mom. occupancy. Job no.: 1 Job site address: / i 2 ( a u. ) G oicA r L % .., i k . 0 Six or more residential units. 0 ttemeational ventclo park.. CityiStateiZiP: - 1 - 7 C .5a, 9 '''? .)- ki E3 mealth-care facilities. 0 Supply Vona ge for more [boo 1:1Hazardous locations. 600 volts wining yll' Suite/bldglapt. no.: Project name: in 5isrvicc us fcalw 600 amp or tooro. — — . .""-- .;;:iA'CiK Cross street/directions to job site: .. 1 1 " 4-1 Di . . • Poo ,■.■ Fee- Total • New residential simile- or multi-family dwelling unit. Includes attached garage. Subdivision: 1 Lm no.; 1,000 sq. R. or less 168.54 4 , - - — En. WI 500 sq. ft. or portion 33.0 1 Tax map/parcel no.:A ..5 I tec ft C7,2 b Q•C:s Limited energy, residential 67 —,,.. .84 2 :. L .! : ".... : ::. , ..,::,;•., •....?.:•• , : .. , ..:: : ! . .;... ,; i .: ::•!:....i.:•. :. ,:LiEs40$7074..;0.....wolitic.:• . :. • :,:; ;.:%:: ...:: f .. i::;:,•. (with above sq. ft.) Limited energy, multi-family 67.84 2 .C...r.....12.,_______ residential (with above sq, ft) Services or feeders installation, alteration, and/or relocae 200 ;imps nr lass 100.70 a •:•.-:::.:.:1:Fiitofitoiii,emitiet.",p:,:,..-r.:.:;.,,,,,,,,- 201 amp5 to 400 amps . liall 133.56 - • 401 amps to 600 3MPS 200.34 2 Name; -in./ *ir • 601 amps to 1,000 amps 301.04 2 }...._ Address: / 0 / s --- ,.-s-t...,,..), Rv t Over 1,000 amps or volts 552.26 2 Temporary service or feeders installation. alteration, and/or City/Statc/ZIP: ------% .,.._ ' c / - 7.9-.- 1 L i ...location Phone: OM ) ( ci g k F ax: (all ) ( ,a 1 - OL (i' — 200 amps or less II 59.36 I Owner inatollation: This installation is being made nn pmpelly that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 00 599 amPs . 10.54 2 grand circuits new, alteration, or extension„Rer panel Owner signature: - Date: A. Fee for branch circuits with M " - ... • ..:':"..: 0:i .!.::. '::',::::: ' '17.77;7...i..a:CONTAMPEP4PN :::'...::........•:; tibuvc service o fc'dtf foe. 3 742 I 11/." 2 ' each branch circuit Business name: B, F ee for branch circuits c------ without service or feeder tec. 56.1S 2 Contact name: ,.......,„......‘ cy-oc-r- first branch circuit Address: 0 - Encb add'i branch citOttit 7,42 _ dress: /13 ta, 5 61.43 tALA c.. .t-r.- Miscellaneous (service or feeder nut induded) 2 City/State/Zir c- Y -.') -) r..) y • Each manufactured or modular 67.84] 2 dwelling. service and/or feeder t Phone: (.51.,11, ) to '15' 4E3(..1 1 Fax: : (941) (031 - 0■40G,5 - Reconnect only 67.84 2 E-mail: t 0 . • - ,. - •- 0. . -. c---c-N. Pump or irrigation circle 67.84 _ '2 ' '•'..'. Y '.: ::;;. .:....::.';..:;-:.. :':'t;.,..,';'!•'..': ..::'..; CONTRA lo :OR .::::::::: ....f ;•;:'::::: %',...C:.::::•••:::7. :::.;.:;.;;;%:,C' Sign or outline lighting 67.84 2 . gloat circutt(s) Of Business name: name: 5 - .«A r nu 6 ferlf...- .E.;ov C. energy pancl, alteration, or extension. Describe; Page 2 2 Address: & ep cc./ ,Z 4TV 6 t,licV2...frrv-e. 6--..4 ...... _„, Each additional C it/St/ZIP: inspection over allowable in airy of the abuve yatc p4 4 i , /:3-.../, q 340.-s.,7 ..... p inspection 66.25 Phone; KZ3 ) -1.s. ,,_. (17 3 Fax: (g•a eeVi-6.5'f4 investigation per hour (1 hr min) 66.25 CCB Lic.: i 2° Electrical Lie.: 3 .Y-- '., suprv- Lic---.52/S industrial plant per hour 78 - I — • ; • t ramarEtts , Suprv. Electrician signature, required! ..,..--- ,"" d;7 ,.. Subtotal; 1,244 Print name: Date: Plan review (25% of permit fee): - r, State surcharge (12% of permit fee): Iv A Authorized signature! TOTAL PEatar Ptit : / 37 V. ----- This permit application aspires if a permit is out obtained within 180 Print name: Date: days after it has bens accepted as mirn0 — • Number or inspections Wilma.' Pia !immix. 1:usundulaviermits\gt,c...Perintuk11odoc teiottoo 440 T / 3). 7 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 I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. .54 iv C--�rr 4 Print N/ I e of Permit Applicant Signature of Permit Applicant Date Permit #: H t'i X;.r/O -60115 1 j C Address: � r'� . • �� ;. A11_1 02 97?-aa • _ `_ ,: ,;, • ZI Issued bk Date: 74 / 1 This Copy for Permit Offices