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Permit T� , N o CITY OF TIGARD MASTER PERMIT a . COMMUNITY DEVELOPMENT Permit #: MST2010 -00067 a � Date Issued: 05/26/2010 T[GAip 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S114AB00400 Jurisdiction: Tigard Site address: 9290 SW DURHAM RD Subdivision: Lot: 0 Project: Strothers Project Description: 649 sq ft addition and interior remodel. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 258 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 16 Bathrooms: 0 Second: 391 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $65,818.00 Rear 0 PLUMBING Sinks: 1 Water Closets: 2 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: 1 Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 1 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 2 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 addl 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) STROTHERS, HARRIET A OWNER 1 MST s ^-f-! cnz 6:1 x44-- 9290 SW DURHAM RD TIGARD, OR 97224 PHONE 818- 203 -0658 PHONE: FAX: Total Fees: $2,943.63 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. At work will be don- • .ccor.- .e`ith 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 day ATTENTION' Oregon law -q,ires ,,.0 to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 - 001 -0010 through OAR 95..01 -010'. ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2 .4/ , a `— 0 I -sued By: � / / Permittee Signature: �� /i Air - Building Permit Application V tl G � FResidential R ��I I ICI .USI O \ 0 d m p� ° o .� 01•Ni . v-wi.1 t . r 1a1.,p.L.,016 ^ ki\, .',,J , : I"M�; . ' ;Irk!' , .' ° 13125 Of Ti ilyd p PR 1 5 2010 Received 4/ is- /C Permit No.: }-r &rp70lt� - Ci'a0( 25 SW Hall Blvd., Tigard, OR 97223 APR Date/By: g Plan Review �? I ® Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/sy: ,./.1 G n i n ; Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: _ ® See Page 2 for ...r Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Y(� Supplemental Information ,pU I lilyyt Ju ri .. / 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. Valuation: 081e r' 3 `J $ "" ❑ 1- and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: D ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: Number of bathrooms: O JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 q 0 S t» 2:- Y h New dwelling area: &I? square feet City /State /ZIP: i ( G ji'a'4 O 1 q- 22' Garage /carport area: ��' ((/ square feet Suite/bldg. /apt. no.: Project name: -( O - (l-' 12_C Covered porch area: square feet j9' Cross street/directions to job site: Deck area: ' W square feet z ,6�; Other structure area: square feet 1 REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. f /) l i) v1 N / .17 .4 & \ O Y - ,/) -� 0 � \e- Valuation: $ ... f'r u tw.o� f� P Existing building area: square feet New building area: square feet ' ❑ PROPERTY OWNER ❑ TENANT . Number of stories: Name: L► y vd S4 j - ` l'�1�X5 Type of construction: Address: 1210 / S (•.) I)Lk y' ha.v,,._. 42 4) Occupancy groups: City /State /ZIP: 71 c' • (BIZ 9 - 3-2_2-1- Existing: Phone: ,e 2. Oo .� 6 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 /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E -mail: . CONTRACTOR Business name: ,G / 1 Z ^ BUILDING PERMIT FEES* Address: L J / J `�/I (Please refer to fee sehedrr(e) — Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: 0 ,543$• o$' Amount received: 3 Authorized signatu ', ,4 This permit application expires if a permit is not obtained J within 180 days after it has been accepted as complete. Print name: LA �i) 5, c74-,5-ht e-r Date: yl /S/ �(� I * Fee methodology set by Tri -County Building Industry I Service Board. I: \Building \Permits\BUP -RES Perm p.doc 10/01/09 440 -4613T(11 /02 /COM/WEB) AIL t Building Permit Application Checklist One- and Two-Family Dwelling tR f ,. . 7: ? V" 5 y g ' :"� ; * : L t 4 I01.4 I ' tIS : t i 0N� A � " , 1114 City of Tigard Received Date/By. Permit No.: q 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated permits: a Phone: 503.639.4171 Fax: 503.598.1960 ■ "`' 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical .a Internet: www.tigard- or.gov ❑ Other: • ;VC- 1° 4'i l r F,OI YO WI V 1 ( S RC , UIREI) F®IZ*I Ef�N RCs IE ;� i' a� ''' _Wu:l `p?{ ' ;'N )''' : IA : ' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ EI ■ 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: ❑ ■ Cl 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- ❑ 1=1 ■ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ■ ■ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ■ ■ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ■ ■ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ■ ■ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ■ ■ floor, wall construction, roof construction. More than one cross section 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 applicable to the sro'ect under review. i I tw1SD1&1 I ONA1 SP CII ICS , -'`, �s ,J, r ,.. 7: , r , Y E A , 3 , � :r -r ,- x 1 1, , .o l . .- _.. -_ .-. ...... . +..-- , .r „ rt.f -cy, . �� >G� .r -di!F.r r7 .. . C+' � Y .N,'.' , . .� . i , -- _ . . 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(1 I /02 /COM/WEB) A Electrical Permit Application " ��' � � 1' r oo m s ` ) �' i,l ' i , ” 74, p � o 4 w 'w, :a � i t7 � . a Yl 'x i.Miaiii, ,a :0 dM. Vol.srt.: ; y"�JIt ) 'hw +1 31,111 111, 07 : y t; Received City of Tigard DateB : (6 /d Permit No` h� j(b_ GXk Illi ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: I I ,, ',' . Inspection Line: 503.639.4175 Date Ready /By: Juris. ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental information TYPE OF WORK , PLAN REVIEW ' . ❑ New construction ❑ Addition/alteration/replacement 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 ", "1 -2 ", "1 -3 ", Job no.: Job site address: R 2 G 0 St'AJ A VA I 00HP or more. occupancy. � � / ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ! / CI `/'� `) ��// a f`— 9 Z ZL/� ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 5: e9 ❑ Service or feeder 600 amps or more. 'FEE' SCHEDULE . Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 • 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. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 . • • DESCRIPTION OF 'WORK (with above sq. ft.) / I Limited energy, multi - family 67.84 2 J (k_ a r_ '41 0 /) a �,l 1 h + e _ - � op r residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 /CC), 7c. 2 • ❑ PROPERTY .OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: II 401 amps to 600 amps 200.34 2 G ✓LcCS``� L j'S 601 amps to 1,000 amps 301.04 2 Address: R Z1 U Sc.-Li ,11,14-kit-1 e Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State/ZIP: I (C a�'►e-) 0 q0 2 2 4 relocation Phone: (810 ) 20 3 Q 25 Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installat' in i being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent . r e'h.) : acco ji i r to ORS 447 670 nd 7 1. �-� !' / S - �� Branch circuits — new, alteration, or extension, per panel Owner signature: . _ 1 E LI Date: A. Fee for branch circuits with above service or feeder fee, ❑ APPLICANT ❑CONTACT PERSON each branch circuit 7 f 4 - v4 2 Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: /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: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: j Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: -�� (� ikvAr Ind (t ( l hr in) 66.25/ hr Industrial plant I hr m 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%2 hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: . 'ELECTRICAL .PERMIT FEES ' ' Suprv. Electrician signature, required: Subtotal: If k.— Plan review (25% of permit fee): Print name: Ethan S- y e Date: g //3//(j State surcharge (12% of permit fee): IS. ,8,. ( _ __ TOTAL PERMIT FEE: 1 Authorized signatu This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.dor 10/01/09 440- 4615T(11/05 /COM/WEB • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: `RE51DENTIAL WORK ONLY: Fee for all residential systems combined ... $67.84 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* ❑ 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 n B • oiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ . Fire Alarm Installation n HVAC ❑ Instrumentation n Intercom and Paging Systems n L andscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n O ther Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L\Building\Permits\ELC- PermitApp.doc 10/01/09 r 4a y7 T'i wf ; 171 � •, f1 �' `C 1 , ' • I. i ' ,•I l �, i �'V ti i Mechanical Permit Application P� y x l' 1 I 1 1 ,, , City of Tigard Recei y : �h �. i p, _ � � (y, �J � 7' = +w Permit No.:/ l �ray D't00� / ° 13125 SW Hall Blvd., Tigard, OR 9 ii,T: / , • ' ' l Plan Review Phone: 503.639.4171 Fax: 503.59..1' , Other Permit: ; ��� LLLLLLI x s D a t e B y: . C `�`:I G A R I) Inspection Line: 503.639.4175 Date Ready/By: tuns: ® See Page 2 for Internet: www.tigard-or.gov APR 15 r 2 p 0 1 0 Notified/Method: Supplemental Information TYPE OF TII D • C 'FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Addition /aillrli t IJLN(i M ]IV I JON Mechanical permit fees* are based on the value of the work 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 ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION • Heating/cooling Job site address: q 2 q 0 S LJ b1.l ✓ h GZ/W` (re Ai conditioning quires site plan showing placement) 46.75 City /State /ZIP: T (( rcp Q 2 9 72-2-, Fumace 100,000 BTU (ducts/vents) 46.75 s Furnace 100,000+ BTU (ducts /vents) 54.91 1 T Suite/bldg. /apt. no.: Project name: �� Heat pump 61.06 Cross street/directions to job site: Duct work X 1 23.32 23,3%' — 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 X L 23.32 S 'J — Other 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK. Water heater 23.32 /) / Gas fireplace 33.39 QC� i h4' vi tt_v..ea / �v ..+ v 'or- /Cei>'vtod �1 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove X.' 33.39 '3 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other 23.32 Name: L i,nd S -41' Environmental exhaust and ventilation I� Range hood/other kitchen Y Address: 2 Lj 0 Si �u- ha -,^-- A equipment )` r 33.39 "333 City /State /ZIP: 7(6 An -D Ole q7-2-2-9 Clothes dryer exhaust t 33.39 - 33 I Single -duct exhaust (bathrooms, Phone: (5 ) 2_6 (Ye 5 a 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; $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 Business name: Clothes dryer (gas) © Other: Address: / City/State/ZIP: MECHANICAL PERMIT•FEES* • 1 `/ Su btotal /State /ZIP: � " � �o ,�I y 1 Minimum permit fee ($90.00) Phone: ( ) Fax:( ) Plan review (25% of permit fee) CCB Iic.: State surcharge (12% of permit fee) 17, 6 9 TOTAL PERMIT FEE I L. A, 4 ° 3 - This permit application expires if a permit is not obtained within 180 Authorized Slgnatur ' d ays a it has been accepted as complete. Print name: L j yt d s . e-r 5 Date: l'5"-//.0 * Fee methodology set by Tri- County Budding Industry Service Board \ \ I:\ BuildingPermitsMEC- PermitAp 10/01/09 444-0- 4617T(1I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: • , Permit Fee: - $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 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 1 "i i� '�` &rli�v �"a�w r"r°�X'L p 'dT 1<if 1�,&�1� r�.) I�M� u,l. � M � il f .. Building Fixtures �'k r ew,.. �a� �I� `� ,,,,,, ,. ,',, g ''" ,3 F ��� ^, y"�I ORrOI I IC 11til ) 1 t fi wl r , �u y li�y pt;,, I ,W �. � - iP1�5�iT�"�"h4�.���, n � -�•. rd bw (ir an i^r iu � „��A�Wri � � -m a.- ush9 �n ru� 1 g E C EIVEO CI of Tigard � • Re ' �Permit No a 13125 SW Hall Blvd. Tigard / PD r 0 . P hone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit No.: Inspection Line: 503.639.4175 APR' 1 2010 Date Ready/By: Juris RI Page 2 for I icAItl� Y y g i Internet: www.tigard- or.gov � 1 , Notified/Method: Supplemental Information ' TYPE OF airOF TIGARD . FEE* SCHEDULE El construction it 1Ry��' ot7��� For special information use checklist Description 1 Qty. 1 Ea. I 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 El 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: ! Zt 0 - (Ai Du y a,ks- 6 Catch basin or area drain 18.76 City /State /ZIP: 77c ,4- /� q q- Z Zy Drywell, leach line, or trench drain 18.76 /) £/L Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: .57-/--y-4717/e0.<5 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.: ) Page 2 Water service (no. linear ft.: J Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 a / 710n a.-7,d __ - -/6r- 0 /✓ ,e/ Dishwasher X 25.02 Z Drinking fountain 25.02 Ejectors /sump 25.02 ❑ / n1 61547 PROPERTY. OWNER I ❑ TENANT • Expansion tank 12.51 Name: S A e9 Fixture/sewer cap 25.02 Address: q Z q (� S C.c., b LfiyLtcC.vw 9 Floor drain floor sink/hub / 'x-. 25.02 Z2502_ Garbage disposal 25.02 25.0 City /State /ZIP: '7 6 Ate 1) 0 C 2 . Hose bib X 25.02 Z5,e� Phone: ( 10 ) 2-03 Q (e 5.-8 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 � /Q / Z )< 3 25.02 76. e.) City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan X2,.._ 12.51 206. 02- E -mail: Urinal 25.02 Water closet X 2_ 25.02 tO,015A CONTRACTOR ` ' Water heater y 37.52 37s~J - 2-- Business name: Water piping/DWV 56.29 Address: A , , Other: Doc) 6 X 25.02 �7. dv City /State /ZIP: IF W_ Subtotal 312 `7Q: Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: _ g Lic. o.: I ��,�� State surcharge (12% of permit fee) hj ?, 75?-_-_, Authorized signaturel��, -� TOTAL PERMIT FEE - 360. 1 - 7 This permit application expires if a permit is not obtained within 180 days s � Print name: y d �/ s e/_< Date: DatC: 9 ®D after it has been accepted as complete. r *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 44046I6T(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 Valuation: Permi 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 Inspections or Fees .Qt 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 Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool -Each Stall ❑ Medical gas and vacuum systems for health care facilities. Car Wash Each tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator El 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 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 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 1 v Community Development r I c n li D Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor tr City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) � t b t A EI R0 l l{ i, P.._5 ,, Mailing Address: q act 0 dtx� - 0 k 214+4 L.I E1j City /State /Zip: — r. 2 `r CV_ C7 a a q Phone No.: % l c g - a03 - O(.o 5 $ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. R . REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: H o2C l O — Cop (1 7 Site Address or Parcel #: S-0 A S 0 Project Name: {ZOT1 -( Subdivision Name: •/A Lot #: EXPLANATION: 0_ ( (4.(0 Cr E206 t o A) Co Q t. ESE 5 I n) E/211.4/2., " 1 60% in Signature: 1 \ ✓ ' Date: 51 a2& 1 t O Print Name: i EJ) gl 4 ('I'D A AA-6k) Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds, FOR OFFICE: USE ONLY Rte to S s Admin: Date gi t 0 B Rte to Bld: Admin: Date /, B .iiii' Refund Processed: Date /'0 2 '! /D By ∎" Invoice Processed: Date By Permit Canceled: Date 14– By ,- Parcel Tag Added: Date By Receipt # /7j ki Date 37 pet Method CC_ _ Amount $ I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 1r 4 D- October 29, 2010 Lindsay Strothers 9290 SW Durham Rd. Tigard, OR 97224 Re: Permit No. MST2010 -00067 Dear Ms. Strothers: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 9290 SW Durham Rd. Project Name: Strothers Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $66.00. ❑ Trust account "deposit" receipt in the amount of $ Notes: Refund 100% of erosion control fees charged in error. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I: \ Building\ Refunds\ Administration \LtrRefund- Overpay.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Lindsay Strothers DATE: 10/22/2010 9290 SW Durham Rd. Tigard, OR 97224 REQUESTED BY: Dianna Howse Debbie Adamski TRANSACTION INFORMATION: Receipt #: 178087 Case #: MST2010 -00067 Date: 5/26/2010 Address /Parcel: 9290 SW Durham Rd. Pay Method: CreditCard Project Name: Strothers EXPLANATION: Refund 100% of erosion control fees as they were charged in error. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Erosion, Control 1003100 -22002 $40.00 Erosion Plan Review - CWS 1003100 -22003 13.00 Erosion Plan Review - COT 2300000 -43102 13.00 TOTAL REFUND: $66.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager / / z// CJ If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: I /e /zf/ /el By: I .tt 1: \Building \ Refunds \RefundRequcst.doc x 09/01/2010 7 1 e ° Community Development I_ c \ IL I � Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor [t City Staff (check one) REFUND OR Name: • INVOICE TO: (Business or Individual) o sb b A g •R - a_ s ,, Mailing Address: q aq 0 1 .1. ) - 0 Lt. Q 144 N ht, City/State /Zip: -- a 2p OP_ q7 a a Phone No.: $1 S - 94.3- O(o 5 S PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. M . REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: H '3T 1O -- 000(07 Site Address or Parcel #: �.,/A -11 A 5 W Project Name: fLo- f Subdivision Name: t4' A Lot #: EXPLANATION: l : ( (2.,Co Gt, E .OS r o n) ( ,0-raa c. 6t 5 „u E k./.De2A 4,I✓u...1v 160 Signature: C _,/ ' Date: 5/g& 11 v Print Name: k___E.P, i j 1 ¢ ( IDA NA6 V Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE: ONLY Rte to S s Admin: Date gto r D . B Rte to B1d: Admin: Date / G • / B i' 'ii Refund Processed: Date f f e •; t By Invoice Processed: Date By Permit Canceled: Date Jv /, -- By !` Parcel Tag Added: Date By Receipt # j)1-411•7 Date $ /r. t: /iG Method CC:- Amount $ I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07 CITY OF TIGARD RECEIPT 111 rn 1 1 " 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD `� t A. ; Receipt Number: 180195 - 10/29/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00067 $ -66.00 Total: $ -66.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 00505C DHOWSE 10/29/2010 $ -66.00 Payor: Lindsay Strothers Total Payments: $ -66.00 Balance Due: $66.00 Page 1 of 1 9 • CITY OF TIGARD RECEIPT I NI a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 • TfCAR Receipt Number: 178087 - 05/26/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00067 Building Permit - Additions, Alterations, 2300000 - 43104 $849.93 Demolition MST2010 -00067 Plan Review 2300000 -43106 $214.40 MST2010 -00067 CDC Plan Review, RES 1003100 - 43112 $46.00 MST2010 -00067 CDC Plan Review, RES - LRP 1003100 -43117 $6.00 MST2010 -00067 12% State Surcharge - Building 1003100 -24001 $101.99 MST2010 -00067 Tig -Tual School CET - Residential 2300000 -24102 $649.00 MST2010 -00067 Services or Feeders - 200 amps or less 2200000 -43103 $100.70 MST2010 -00067 Branch Circuits w /Purchase Service or 2200000 -43103 $14.84 Feeder MST2010 -00067 Duct Work 2300000 -43102 $23.32 MST2010 -00067 FlueNent For Any of Above 2300000 -43102 $23.32 MST2010 -00067 Wood/Pellet Stove 2300000 -43102 $33.39 MST2010 -00067 Range Hood /Other Kitchen 2300000 -43102 $33.39 MST2010-00067 Clothes Dryer Exhaust 2300000 -43102 $33.39 MST2010 -00067 12% State Surcharge - Mechanical 1003100 -24001 $17.62 MST2010 -00067 Dishwasher 2300000 -43101 $25.02 MST2010 -00067 Floor Drain /Floor Sink/Hub 2300000 -43101 $25.02 MST2010 -00067 Garbage Disposal 2300000-43101 $25.02 MST2010 -00067 Hose Bib 2300000 -43101 $25.02 MST2010-00067 Sink 2300000 -43101 $25.02 MST2010 -00067 Lavatories 2300000 -43101 $50.04 MST2010-00067 Tub /Shower /Shower Pan 2300000 -43101 $25.02 MST2010 -00067 Water Closet 2300000 -43101 $50.04 MST2010 -00067 Water Heater 2300000 -43101 $75.04 MST2010 -00067 Misc Other Fee 2300000-43101 $25.02 MST2010 -00067 12% State Surcharge - Plumbing 1003100 - 24001 $42.03 MST2010-00067 — Erosion Control 1003100 -22002 $40.00 *-- MST2010 -00067 –� Erosion Plan Review CWS 1003100 -22003 $13.00 MST2010 -00067 ._s Erosion Plan Review COT 2300000 -43102 $13.00 L Total: $2,605.58 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 00505C DADAMSKI 05/26/2010 $2,605.58 Payor: Lindsay Strothers Total Payments: $2,605.58 Balance Due: $0.00 Page 1 of 1 R E C E/VE D Property Owner Statement APR 1 5 2010 Regarding Construction Responsibilitig 1 OF T,GARD Oregon Law requires residential construction permit applicants who are not licensed wlfhh I VISION 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: I own, reside in, or will reside in the completed structure and my general contractor is: I I 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 h a l I will be performing work on property I own, a residence that I reside in, or a residence that I will I►' 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. Lj a �i Print Name of Permit • •pli. n 15 dor � l Signature of • -rmit pplr nt Date Permit #: N i - OOOCQ 7 � g0 A -1-4 Address: ` # : 17 1uis , / /1 4 n 97 , / i. T ic .: • • Issued b Date: 5/944 F _= This Copy for Permit Offices This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. ::: ''' a BUILDING DIVISION a :_t,1 c n ft D; LETTER TO: DATE RECEIVED: DEPT: - G DIVISION RECEIVED MAY 1 9 2010 FROM: -- \ N ,CD c S--1- CITY OF TIGARD BUILDING DIVISION COMPANY: A r r s 1 C�� PHONE: X03 - 725 08S 1 -?........... f . fa\ Q.0 l I—. --C--- rte ress (Permit/Case Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): ? 11 REMARKS: Ct-e c� FOR 9FFICr USE ONLY Routed to Permit Technici�an Date: - /" -- 105 .- ate: / 5 j _ (O Initials: Fees Due: ❑ Yes I Vi'1 o Fee Description: Amount Due: $ $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I: \Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07 i