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Permit di e / / /l 4,,,, /1V/ 0 tI / o ( vVCI Vt( ( ( 691,-, J (7 CITY OF TIGARD MASTER PERMIT 11111 " 2 • COMMUNITY DEVELOPMENT Permit #: MST2008 -00013 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011 Parcel: 2S102DCO5600 Jurisdiction: TIG Site address: 13874 SW HALCYON TER Subdivision: Lot: Project: GERTZ HOMES AT EDGEWOOD Project Description: New SF. 2/9/11, Reprinted permit to include (1) sink for wet bar in bonus room. BT. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1428 sf Basement: sf Left: 5 Parking Spaces: Height: 24 Bathrooms: 3 Second: 1650 sf Garage: 754 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $324,000.12 Rear: 15 PLUMBING Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 100 Urinals: Lavatories: 5 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Storm Sewer: Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: Bckflw Prevntr: Footing Drain: Ice Maker: Hose Bib: Backwater Value: Other Fixtures: Drywell- Trench Drain: Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 NAT Heat Pump: N Hoods: 1 Other Units: Fum<100K: 1 Vents: Woodstoves: Gas Outlets: 5 Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add! 500 sf: 4 201 -400 amp: 201 -400 amp: W/O Svc/Fdr: Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp: 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: NEW SF 5N R3 Owner: Contractor: GERTZ CONSTRUCTION COMPANY, INCGERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions) 19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 681 - 4444 TUALATIN, OR 97062 TUALATIN, OR 97062 PHONE: 503 - 692 -3390 PHONE: 503- 692 -3390 FAX: 503 - 692 -5433 Total Fees: $13,156.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throu. • ' R 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .—. / Issued B!� — , _ -- Permittee Signature: � ^ Call : . ' by 7:00 a.m. for the next available inspection date. / This permit card sh. , • m a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each inspection. 7 ,, CITY OF TIGARD MASTER PERMIT li COMMUNITY DEVELOPMENT Permit #: MST2008-00013 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011 Parcel: 2S102DCO5600 Jurisdiction: TIG Site address: 13874 SW HALCYON TER Subdivision: Lot: Project: GERTZ HOMES AT EDGEWOOD Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1428 sf Basement: sf Left: 5 Parking Spaces: Height: 24 Bathrooms: 3 Second: 1650 sf Garage: 754 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $324,000.12 Rear: 15 PLUMBING Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 100 Urinals: Lavatories: 5 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Storm Sewer: Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: Bckflw Prevntr: Footing Drain: Ice Maker: Hose Bib: Backwater Value: Other Fixtures: Drywell- Trench Drain: Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 NAT Heat Pump: N Hoods: 1 Other Units: Furn <100K: 1 Vents: Woodstoves: Gas Outlets: 5 Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 4 201 -400 amp: 201 -400 amp: W/O Svc /Fdr: Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp: 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: NEW SF 5N R3 Owner: Contractor: GERTZ CONSTRUCTION COMPANY, INCGERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions) 19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 681 - 4444 TUALATIN, OR 97062 TUALATIN, OR 97062 PHONE: 503- 692 -3390 PHONE: 503 - 692 -3390 FAX: 503- 692 -5433 Total Fees: $13,128.59 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 ..opted'-l2y the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain , • • • • - I •r direct questions to OUNC by calling 50 2132.1987 or 1.800.332.2344. Issued B. • --_ •� _ _ <L ter ___,--_;...el -ermittee Signature: Call 503.6 •.41 19:00 a.m. for the next available inspec ' n date. This permit card shall be - • in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. „ 'Plumbing Permit Application Site Utilities VO FOR OFFICE USE ONLY City of Tigard Ri Permit No.: n III A Date/By: q /1 / s iricY 4 coo i 3 13125 SW Hall Blvd., Tigard, OR 97223 ' Plan Review Phone: 503.639.4171 Fax: 503.598.1960 s 9 Other Permit No.: DateBy: TIGARD Inspection Line: 503.639.4175 F ` e Ready/By: Ju ris H Se Page 2 for G Y Y Pa g Internet: www.tigard- or.gov ^ �A � I Ot i ft ed/Method: 77 Supplemental Information TYPE OF WORK CVO' OW FEE* SCHEDULE 12 New construction ❑ DemttM ' For special information use checklist Description I Qty. I 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 ''and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 ❑ Accessory building SFR (3) bath 500.32 ry g ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler C sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: � 35- �\ , / -1-4 Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State/ZIP: - rI (, ALD i OP 0111223 Footing 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) n misizA -- 'SL Ci 1 1 Rain drain connector 18.76 � i.' 01- ICJI� T � Sanitary sewer (no. linear ft.: ) Page 2 'E L Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �( _ Clothes washer 25.02 // t ) y ∎Li l )1\e_ _ 1 , C` 1 v � , . ' /i Dishwasher 25.02 &01` i/ J1 1 wt L 1 - tC � 1-D LU S MO Drinking fountain 25.02 Ejectors/sump 25.02 12 OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 Name a4 • r AM U a 8 Address: vq 200 s A O a Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State /ZIP: 7L0 t, - ( 0 6 110(62_ Hose bib 25.02 Phone: ( / 0 -2 - y g 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 t 25.02 ,)-5 „ Od.. City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: r .'! � f;.,: .t _401 ii. '1 .! - Water piping/DWV 56.29 Address: / /7 Other: 25.02 City/State /ZIP: / ' ' , , Subtotal Mi permit fee: $72.50 • S Phone: (503 ) �7 , 7S Fax: ( ) /j CCB Lic.: / Plumbi .. Lic. no.: Plan review (25% of permit fee) Mr' - State surcharge (12% of permit fee) 3-a) Authorized signature: / /j . � / TOTAL PERMIT FEE Oa, • Print name: + A q ? 1 This permit application expires if a permit is not obtained within 180 days Date: 1 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 - l' 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 Inspections or Fees 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 Bath - Tub / Showcr ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher -Commercial Submit 2 sets of plans with any of the above. - Domestic 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 lumbin permit can be issued. Water Extractor p g p Water Closet - Toilet Urinal Other Fixtures: I: \Building\Permits\PLMU- PermitApp.doc 2 f I . a Site Utilities — Plumbing Permit Application Plan Submittal Requirements TIGARD A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. 1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn to scale) labeled with: A. El map & tax lot # ❑ project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name ❑ phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads with project location. 2. PLUMBING PLANS - Two (2) complete sets, civil only. All details listed below shall be incorporated into the plumbing plans: A. Storm drainage plan showing: 1) Finish elevations throughout the developed site. 2) Grade breaks determining area serving each catch basin. 3) Location of catch basins. 4) Pipe size. 5) Type of material. 6) Slope of piping. 7) Manholes and field drains. 8) Cleanouts provided for each 100 feet or fraction thereof. 9) Roof drain laterals specifying cleanouts at each upper terminal. 10) Location of existing or proposed connection to a public sewer line. B. Utilities plan showing: 1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes and cleanouts provided as required for storm. 2) Size and location of domestic water piping and drainage. 3) Proposed location of connection to a public water or sanitary sewer line. I:\ Building \Permits\PLMF - PermitApp.doc 12/30/05 Building Permit Application f II ReSidelitlal z A , FOR O USE ONLY I City of Tigard + " J Received < P ermit No.: py jT� c e 04 ° 13125 SW Hall Blvd., Tigard, OR 97223 Date Phone: 503.639.4171 Fax: 503.598.196 : .�/ / / • / vriti- `� " CJ `' : • ►6 ` m Plan w•� ♦ t ► ' p DateB ReviC ���(� m Other Permit: �2 �V ' TIGARD Inspection Line: 503.639 � ` � g , ' ! �1 Dat eReadyfBy:� See page2 for �l Internet www tigard - gov • - i ' � li V at ut m Not,fi . ethod, i� Supplemental Information {�4'° , >rte !. kax -v a � 't tM A i � ���t<. .. ,. s +,, r _ i �x"g i C" Q� A '' E '{ V ° h' t ` _' 4 m.3 e to r" r `l'`' ,.{ ., �] '. 4 r - y: . ..; .,`� T1.1...a -`rr',to, ,thg :.writ#t:`ror's`s.a 4...4', t`. t,.,,.s , ,„,-a�l:..0,a,; i:4,, ,,,,,, i y:. ^..7 ".: i't:_, ,` � a 2 v ,, ,',' `' l REQ IIf „„ :�e � „„ ” •a ,m 441 N 1. 4^5�. d:k3s h,,:r S_Lpaat�.rowd� .���� , c � �Ma+ . mom.. ® New construction El 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, overly.,, ■ and the profit atEe N eM i ` a � f liti f � ` :� `�a " 4 - W 's , .Fi work indicated on this a licati • ' . / 2 � m O +�t -. &0 � � )Q.4Ta i'G ©R`Y-, v .. CUI STSRtiICTetdl� - "� ' 4 :V ,r. PP �• ., x' ..w.,x, . � � r<,�x �. +,� n��a�a ,�5s�dta5a..�+„�,..a"rr .� ..,z�, � �;�r u,� � ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ q 3 �Q ❑ Accessory building ❑ Multi - family Number of bedrooms: --- c/ ❑ Master builder Number of bathrooms: 3 0 + Fa ra.r aaa ¢%8u4k4'c guava^+` ea xtr .wed a+ g. =' {4 " 16 i o R1a ON Cr �' : . 4, Total number of floors: Z r Job site address: /3 97 L( 5 j �4 Z ` `� e � oCe New dwelling area: 3 o �2 square feet 30'78 City/State /ZIP: ' l 9 QQ . og G Q� J /7223 Garage /carport area: .6,-5:0— square feet 7S Suite/bldg. /apt. no.: v Project name: �-,LZ /r - jJ G,7 eolyc Covered porch area: eig square feet Cross street/directions to job site: / � 4 !! S ¢ - lea ,c et N Deck area: 3y square feet 49 /k k 1 / -Q . 6.( e J tr b q Other structure area: square feet (/ .xY Y7 i. '.' "d.{ 5' •i. S! 7' ,zu,G { .a a"'r: F 41RE GO€ tf . Subdivision: 6 Ap op ,t .. t , dd 4 Lot no.: .a. Permit fees* are based on the value of the work performed. Tax map /parcel no.: 2 .s 6 Z L' d � Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the .�ys"�� "; d��Ot`, �"'"_��� +"��`�n�`n4��•. u� axw,2,�^�r�����s� r„„���^. a ,r.� VAST e p 1 , ,� x,.., 1 , 2 }„� 'z � ,DESGRIPTi N WdR 1 a ° � ' , work indicated on this application. Ne 4.5 1 e_ Valuation: $ Existing building area: square feet New building area: square feet : r. l � .� e :.' 4•,. 1 I �� titi., . h, g 464 � Number of stories: Name: � Coe_fa Cow S.=CR k c t a N Ca nt, a Ar r Type of construction: Address: 17 2 6 0 S C J 4/ 4 A Y e. Occupancy groups: City/State /ZIP: ?4a e a:1IA( OR 7 704 Z - $ ?7 Existing: Phone: (5 ) C ? Z . . - 3 3 ? 0 Fax: (S 3) C ?Z— .5—Y33 New: piker t' `. ' u cd,. «i 1 �g 10 ; , V l e ?aigi tee ,, ! ... t , 4.1P ` . - f ` 5.u�K+r`:s A� , il, -, u,. F ` 144' , � Q v 7*4ml Ir1 t ,'''- , *'; r� Y vow' h�r �'t ,I A f +SJ.f.54 ' !^:' [ivy J � g q , ''''ate .,4 � ��... � ,� r .,x,,. ,,. �:. r? �s , . axF.a ��.+ ,., �h.�.:I:� 3 Yr�! n � T � '�" � c -�a �i s ' 9 � r � 3"� " «:�a.,.� �, '�r� e s-` +..�. £: „�` fit•' v? �; ? .. 4' ��u' w�;', ����cr� ..�' ?� ���+� �;^? i,E�e.?`,' Business name: G eA. f, n:,^4 5- fit ti e 17 6 l a !ed c All contractors and subcontractors are required to be Contact name: ie,e,� q e et t z licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: ',zoo j (, j vt, -f urisdiction in which work is being A . jurisdiction g performed. If the a City/State/ZIP: 'f' 4 j applicant is exempt from licensing, the following reasons q K D/Z `T 7OGZ- apply: P g> g Phone: (S°3)' 7 Z - t 3 / 3 � ? ) Fax: : (5 3 3) rf ? Z - s Cf 5 3 - E mail j <eN �.x �7 ede - t z., e 6. r4 oft t' .n f � . > If ,...; arti:. l eiit "�i`3,,� ' T All tp* '4t�..�i, ` 3: Business name: /+ bs0 sb : ` � @ tF„i,D. I t °F C � h S u: 1 LL►�/t��2_ -- �/v 'li f/2(.LL.�' CD'� t�6 4 L "� �'3',��', .ti�kt ., �” .» � I Address: / 9 400 S W 4 /L 44 A -Y e. t x#r fi +'r "a? �2t'i*k. aa, . 3. to . , t c I d d City/State/ZIP: 6 7 I4 .- ;!V 6L` [ 7 1 ‘ 2- e 7 7 Structural plan review fee (or deposit): - 7 . Phone: ( S�3) 4 ? Z - 3 9 0 Fax: (S 63) 6.9 2 - 5 Y 3 3> FLS plan review fee (if applicable): Total fees due upon application: ' CCB lie.: 3 413 5 Amountreceived: Authorized signature: ` This permit application expires if.a permit is not obtain( ,.............„( / `{ within 180•days.after it has been accepted as comply Print name: 4 e f,__ Date: Z 2,:-G' a` *- Fee methodology set by Tri-County Building Indust, rvice Board. I:\Building1Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM /WEB) .. Building Permit Application Checklist One- and Two - Family Dwelling F OR o Fr c� USE ONLY III City of Tigard _ Received a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Permit No.: C Phone: 503.639.4171 Fax: 503.598.1960 dssociated permits: 24- Hour Inspection Line: 503.639.4175 , ❑ Electrica p 0 0 T I G A R D Internet: www.tigard- or.gov . ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW, Yes No N/% I Land use actions completed. See jurisdiction criteria for concurrent reviews. - 0 - 0 ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ • 4 Fire district approval required. Name of district: ❑ ❑ ❑ '5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 - Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ' ❑ ❑ ❑ • building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size . sheet attached. to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. ' 11 Site /plot plati 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 a to the . ro under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 4 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 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 accompanied by 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. • g ilding \Permits\BUP- RES- PermitApp.doc 03/21/06 440 -0613Y(Il /02/COM/WEB) Mechanical Permit Application , '' F OR OFFICE USE ONLY T City of Tigard ., Received r Date/B /( Permit No.: 13125 SW Hall Blvd., Tigard, OR 97 , y ' % /__ • " C 5 Phone: 503.639.4171 Fax: 503.598 '. E \ j a Date/By: Review Other Permit: TIGA Inspection Line: 503.639.4175 i IjUB Date S or CJC 7)�e� Internet: www.tigard - or.gov FE B 2 Notified/Method: eed d/Met o: l ur i s: to See pen iI nr MID Method: Supplemental information A f :av " ei '" ' t$ P y r`^.. rYR' o . .W Na 6 il ? -i .. arr s . ' � ,,' a , . , : r yr _ _ .x i e rµ axi C OMM R' Fe -„zi, I i I ; •" E � 1 ' 4 ( ' Mechanical permit fees* are based on the value of the work NI 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. �^ e� � ai �„xu a t "x�cw °z; a Ksmx� aa. Bx+ uEr rr�€ a a k A a' 3 r ^� r • . .t ''. ., 1a `: 5110 W It3Yh OF.+,' CQN,., ltr w I�A �'r IIa � #_. ,,- . r.a:rc ; <.. uAv; r • r .. .. v-- s xa -: l R'ESID II f i .A. . ` lY s I Fr8 *" 3 j�l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building s . For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: ;x'? i d F.p3` * t 't �.,a•. ay.,a x; y a,r , *wws arw� -'k tt ca r - v. Description I Qty. I Ea. I Total �!, ...; : , , i 1JB S etl lii,.4- Q ! `" t ONA„,L LO AT)!'© t �* Heating/cooling em u,.. ,� � ;,� u�.,., „�, �,._, r ,�"� p1 Job site address: 3 g? Y f co /A ! 7" Air conditioning or heat pump IwadC a (requires site plan showing placement) 14.00 City/State /ZIP: G Q� 0 A_ T72.2..3 Furnace 100,000 BTU (ducts/vents) r 14.00 J Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: ucts - // / Gas heat pump 14.00 /'I�4 Cross street/directions to job site: l( s. (,J e 37 4 N Duct work 10.00 O Nt et /1 - 4 , 1 E / / Hydronic hot water system 14.00 `C? 4t( es c ' 0° tC Residential boiler (radiator or hydronic) 14.00 _ Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: � e .5 pN EL e wa-ocC Lot no.: Flue /vent for any of above 6.80 e el_ # Other: 10.00 Tax map /parcel no.: Z 51 O 2 1) C a SG Other fuel appliances �'41P" � ,, g a •- L-a= -wR s+a d .ta x Ch'a`s �aaa �,cc ,i� a a �aF� Y I,.,tt �, a . x:. 4 ?e� , ;f r€is, ` . UESC UN, OV WOW � r , `�`; Water heater 1 1 0.00 x.F,d.�t« '"Y�;s , k'a;.r�� M. c � ti � -, v.� W � , :;1a�F,�.c2� +�wa" ��.w ,"^�>�s �ai`�. ;i ���n„ Gas fireplace I 10.00 Al c ``$ o 'G Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 4 a P ' R ' . i .I 4 r * „ " h n ' :� �t `"wili� himney /liner /flue /vent 10.00 �. _ l a., 10.00 Name: G e/ttr. Co Ns e 14, .-,e) b lip+ C- Environmental exhaust and ventilation Address: / elZ G 0 54i VC "- AA Range hood/other kitchen !T V Y equipment r 10.00 City/State /ZIP: /Lt 4 Cm) ,, . OR g 7OG Z -. 8 7 76 Clothes dryer exhaust I 10.00 ,. Single -duct exhaust (bathrooms, U Phone: (� 63) G g 2,,. 3 3 ? 0 Fax . (3113) 0 2 S 3 toilet compartments, utility rooms) �1 6.80 0 . ' r" t �. WOWS, O(y t, I �a K` Attic /crawlspace fans .w.r �� s'�5�. .>:, ���C� PER §�����t'��� .,�. .10.00 �o Other: 10.00 Business name: G eaf2_ Cp$¢, t 4 x 4/c. Fuel piping Contact name: ` { , C N t ' , - 1 L �/ $5.40 for first four; $1.00 for each additional Address: / 7 z p p S cci Y4 �+ Ail V Furnace, etc. Gas heat pump City/State /ZIP: "IL Q 6e, f,iN OA 2 70(2 - S 7 70 . Wall /suspended/unitheater Phone: ( s' � o3) G 7 Z -7 3f o I Fax: : ($-O 5 p Z_ S' 3 3 WaterJeater 1 Fireplace i E-mail: `Clek @ test C o , cc Ae-f Range a ., r m ..t 0,1 b a .10 , f • -" ' " r� r x f,.,, Barbecue Clothes dryer as Business name: bye . r , 4 , �f ry (gas) q Other: Address: P, 0 , 4 p x PTO O i',"1 W .,: ., N . 6II ° ,,'` Itt City/State /ZIP: 6 q b !e, Cite e s '/ 7 7 � 2 Z Subtotal / . - Minimum permit fee ($72.50) Phone: (S'6 3) to . d' Z Z ( Fax: ($03) G.S© - 2.7 3 Plan review (25% of permit fee) CCB lie.: 4/2 5/ ! . State surcharge (12% of permit fee) /J TOTAL PERMIT FEE Authorized signature: // This permit application expires if a permit is not obtained within 180 Ai CJn. J6 i days after it has been accepted as'complete. Print name: g.oK g 5 Date: Z - ZQ - d's� * Fee methodology set by Tri- County Building Industry Service Board I: \BuildinglPeemits\MEC- PennitApp. oc 01/19/07 440.4617T(I1 /02/COM/WEB) 2 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial. Fee Sched $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and - — $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. • Note: All new commercial buildings require 2 sets of plans. I: \ BuildingWermits \MEC- PermitApp.doc 01/19/07 2 Plumbing Permit Application Building Fixtures ] �r FO OFFICE USE ONLY City of Tigard 3�i ECEIvED Received 1111 a 13125 SW Hall Blvd., Tigard, OR 972 3 Date/By: /(/ ►�� /377- Date Permit No.: /1137- ,� ��t� I ` Phone: 503.639.4171 Fax: 503.598.1 2 g / 0008 Plan BReview y: / - Q Other Permit No.: S(, - GC"�FJ- 1 Inspection Line: 503 639.4175 T I G A RD CITY OF T D Ready/By: luris. El See Page 2 for Internet: www tigard or gov Y Y C1.' Date Ready /By: of fie l i -WSJ ..,._. Notified/Method: d/Me thod � ,r$� °� �,w �u sruu � ks +fit Supplemental Information r*� M� %era n ''s 8 ,; g a a .,,, , } +r of � it- = z ,...,, .... =vs ,s... a ''.�a:' "" '. T'�+� '� . r i.'.. .,, ,� P A 0 i . n, �i+'.e. f , x as >'. ` ' ..tor?,;,-- ' +. - J '�i, � � rG�., ��.e1�..,,.a'w���::�ux -sue. �n �,�u�„a,� 9. :.t � U,�� .. .f . , .. .?.�'< r r s� � iiarsl# i , `�'�� F ArNew construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection) $*e•"trt :3 ti � .k x. ... ^a a �+v `x n a ,s:.y �+ c.� •t m n s M „ r , " , .. E :• C fira, OI2Y4O G® S;T z,.� 31r ON 1t. " ;., t � 3 � SFR (1) bath 24920 1 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath I 350.00 • ❑ Accessory building El Multi-family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fires sprinkler �1 ! w a w Pa qx� �za r a P ( Sq. ft) Page 2 l tr r 4;,; ` d, Q „ STS' lF� UN ' 1D 4L.,, ®lti �t'' � ' ' `` Site utilities Job site address: / 3 8 7 Y S (J /11-4 !< d M T RR e C e Catch basin or area drain 16.60 City/State /ZIP: `ft/ a 4, d OA. ? 7 22 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _ ) Page 2 / Manufactured home utilities 110.00 Cross street/directions to job site: N `t S7S 4.). f 7e coy Doi 4 A 4 '7 O �e / 4 • , aj e d Manholes 16.60 t/ Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 4 e#4 .4 . _ �p ,e s , -. e4e,s 0-04 Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no 25/02, o C o 5 o o Fixture or item Absorption valve �' ' d ,. r*»`x a . a?s r rt.atsre i M' a 2 ,4S y a+� [ , .?r. a.+} 4 rp 16.60 S i „ rt a,k.��,§ rkzZ II Il S ( e, � � '� Ok k ' ' � g ``� . Backflow preventer Page 2 / .e t...3 14 !st i! Z. , ,._ 3., 4 f Backwater valve 16.60 - Clothes washer 16.60 Dishwasher 16.60 � �� a. �k Drinking fountain 16. 60 bi b$ xH)4� r 1 r e _ , a� . Qa', �x Aa .�`i. l,1 '* 'O r > • ! f Ejectors /sump 16.60 Name: G c�.,eL_ a J S'- /4- a es& ltl Expansion tank 16.60 Address: '/ 9 Z oo S W LV , 44 A V r Fixture /sewer cap 16.60 City/State /ZIP: - 7 - 4.2 . /*. 2 ( , K 6X f ca 2. - p ? 2 a Floor drain/floor sink/hub 16.60 Phone: ( 5-03) Gp L_ 3 96 Fax: ( 5 - 63) 6y 2. _ ,'"Y 33 Garbage disposal 16.60 - ,, , y 4 P t e I�s'V �,ey � 4 • ✓S(, r -P s ' e aF.51 ,t W ■ 4"f Hose bib 16 1:,,,,-44,M440,,,, � � , d> i ,,,It ® CON •FA , R( - , 4 ,,, , C , t,tn... _� .+v` , ..its,, 6 z tn. ss � s1e.ao w vs,_ Ice maker 16.60 Business name: a .".74 2-- (• rszi� 4,,..t. - 6 - 40)„„) A /,,,e. Interceptor /grease trap 16.60 Contact name: KC Al G TA_ fZ- Medical gas (value: $ ) Page 2 Address: 1 9 Z 0 v .rd....) d G 'L5 A u r Primer 16.60 City/State /ZIP: fit 4 L q {.(% Ai r O A_ f ?DC Z.- g 2 2 6 Roof drain (commercial) 16.60 Phone: (36� 6,1 3 9a Fax: : (Sa3) G. 2 - Sink /basin lavatory I 16.60 '��� Tub /shower/shower pan 16.60 E-mail: / f2G.D ��x_ � r �- �� Q' t f� s�K 6 r �' t .,'� � l J F Urinal 16.60 ' T' , a " to ti t rN GV fi t Y i d, '"' u a< �. a r i �x EN i .. '..,, a i , mm ' `�..a,. .7 �, .,. r t` ,, +,nom n`-i.` i t t. .:,` W ater closet I 16.60 Business name: 7l,t, (roc 1 /`� `i� Water heater 16.60 / Address: i Q /3 O 2 7 y Other: Subtotal City/State /ZIP: 4J e S -I- I, i Iv AI D 4, 1 a o G g Minimum permit fee: $72.50 Phone: (so3) 931_ 2 3 g /. Fax: (5 4. o - i Z 12 Residential backflow minimum permit fee: $36.25 CCB Lie.: / 13' 7 9 z l Plumbing Li c. no.: 3- 2 5"7 /05 Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: ,Q, TOTAL PERMIT FEE Print name: / of c j . 4. /7 < <rA,IB ,. Date: Z=-2 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\PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: .� ? '�``���� VMS Srt � , ., @, l ,t ` `t ,Q I EV),, V�aI Std �00 a � ?peIlftSrm Footing drain - 1" 100' ' g 55.00 0 to 2;000 $115.00 Footing drain - each additional 100' 46.40 2 3,600 $160.00 Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 s ` /o Water Service - 1st 100' f 4.a� w r-14-4 g45 0 , ` / /� f Medical Gas Systems: Water Service -each additional 100' 46.40 W , -u��� �, , Storm & Rain Drain - 1st 100' 55.00� �eltee �3 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each w '� `� yiko of additional $100.00 or fraction thereof, to and 4,, � " " '^ ' la t,,,m including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the firsr$10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25 ;000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: ; ;` ` rg1tiI ev >rew rfo nlu46iait g I'i s alt "i �t us Are you capping, adding or replacing fixtures? If "yes ", Plan review'is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and ce € greater, except systems designed and stamped b Vat nIt � � m �� ,2rkP�r€a��d� � P Y licensed 4060:At'Aft* } "_ dace l7 engineer. ' ge i► � • $ � " ;.>i New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. -Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain � M ' r �� , i . x o- "k "r V I .Test ` R g t ,., A4 itl4tl'IC O Ri5 1 Ya jl? It �. t P . Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. - 3" -4" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory • - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit. will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter • plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is Building \Permits\PLM- PermitApp.doc 12/27/06 Received: Dec 24 2010 10:33am C c ilic 24 2010 11:14AM GERTZ OFFICES 503 692 5433 p.1 Electrical Permit Applicati 0 ( , � ; :: . . wiz ;,1:, F. I SI. ,,\„ City of Tigard �E 2 8 2010 nets Pexmit No,,�p08.- • 13125 SW Hall Blvd., Tigard, OR 9722P Review ' g ' Phone: 503.718.2439 Fax: 503.598.1 : Other Permit: t , Inspection Line: 503.639.4175 C I t Y OF i iUPt pang Date By: Page Page for Internet: www.tigard- or.gov , LDING DIVISION No tilied/Mexbod: I��ii ® q�, • 4y � a 1V 6, Supplementallnformaaon . . 741- + ri `+ YY g ' , �.W,� niFN Da .3;....,.::::„',-;?.;-w,4 i . y 3 , ,P ,, ,, ,s ; ur t ` ' ..o.L -f,, lr"'v, T i en <+ 1W5 n. a f , 4 • Si s, s'. q;8 a.. -" e46 r Mze . r ti Y4 -: .,�, , cS `n Al r 4'. , 1 .Ms' '" ? :te V. i •i ifr x ii a r . t. 1'Nel. t ak. r- !!l ow construction ❑ Addition/alteration/replacement Please chock all that apply (submit ac of � plans wlitema checked below): ❑ Service or feeder 4(10 amps or more ❑ Building over three stories. • Demolition ❑ Other: where the available fault current ❑ Marina and boatyards. y3 t Wis..' „ a l l 'd: w r: pr 5 t a " .g ` r µ %o r R k 3w tar ,? i3? .- vi �` =coeds 10,000 amps at 150 volts or ❑ Floating bu ildings. u 5"'t' °51°5 lees 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 4 . q r e- t T F c, ' l - 1 ,7 ( ��%, - 3 , yr� . r t s i ❑ Emergency system. larger separately derived system. • r •:e r J 3 ' is a r„ ? -.,° , . .. . t . ...'' ,,;Gl' ❑ Addition of new motor load of • Job no.: Job site address: /9,5 �uJ ,�l , 100HP or morn occupancy. F 9 C.s7N > ' - D SO( or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations 600 volts nominal. Suite/bldg./apt no.: I Project name: cr Es .7- ❑ S87Yice or feeder 600 amps or more. '+s", , » 4 F` " �2i'�s e sf TS3:1 4" tis'.,z y N .+ .1; Cross street/directions to job site: & 6 4r . Z:, oaerteao. air. yin Total l■ New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: / 1,000 sq. ft or less / 168.54 4 Ea. add'I 500 sq. ft. or portion 'f 33.92 1 Tax map /parcel no.: a Limited a .�.. 5 v : 'r, f �I.: x r+e °' ' ' d •9 0 'da f.:.;,1/ ` s ,, , x . energy, . ft . ) residential / 75.00 2 ,o.> r ,., ' r .s � . , ;•,,,-41t . . .. ,, ..-1 N c4 a '� r :we-? ' t tf. :,, (With above a ct. ft 1 _ (( Limited energy, multi- family 75.00 2 [�,-`�� �• f t 1nCi residential (with above sq. ft) Services or feeders installation alteration, and/or relocation T. 200 amps or less 100.70 2 ;ly m,dr,° �aa� 7N s;~ ;:4.111,;:41.71,;',9,,, r Y Au �� �.'� � �34 W,.16.:<I'�+ � 6 i .7,14:`.,-': ... ass's ��' * :6 %:3 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 55226 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I Owner installation: This installation is being made on property 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 to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, r panel Owner signature: Date: A. Fee for branch circuits with a 1X, ^, ` ; . : T er, . 7 jfirsa.Y ` -, -: -- V ' t r .4 • ".., ,t ` tar eboveservi eorfeeder 7 4'�° �t ':: each branch circuit 7.42 Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each edd'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 dwelling. service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: . - ��� Sign or outline lighting 67.84 2 ° &5 �.,.. cvarL�:&s:ua i or ` ' i Si g nal • c or limited-energy pa Business name: /� panel, alteration, or extension. _ Page 2 2 /.. . C' .e , c C 0 c t C7 d+U t6 additional inn ptxtion over allowable in any of the above Address Q Z Cb . 6. ,a(� 44 Add itio nal inspection (1 hr min) 66.25/ hr City/State/ZIP: SQ„t, 4/t_ 4 a .9:5-- investigation ipat 1 hr min) 78.18/hr min) 66.25/ hr 4 industrial plant (1 Phone: (f? 3) 2 a `- 56 )•.. -•• I Fax: (y>3) C G Er- ''f5 Inspections for which no fee is 90.00/ hr p 7 3 s `call listed 'h be- mm D CCB Lie.: D' T7.-1- Electrical Lie: C Irv' Lie.: 11 J .5' i .. - ! i r. . i s t im x .!- i ' i , :' .? ;ice _ Suprv. Electrician signature, required: ,4 Subtcaal: Plan review (25% of permit fee): Print name: d_ a- ,� „ 2 p , } Date: State surcharge (12% of permit flee): rriirr "" ��"""°° TOTAL PERMIT FEE: Authorized signature: �/ This permit application Ire ppueatloa expires it a permit is not obtained within 180 days after it has been accepted as complete. Print name:: • Number of inspections allowed per permit. r:\ BuildigglPermitr AII.C- PemitApp.dac 07ro1110 saaasgsr(r l/os/Comewaa Received: Dec 24 2010 10:34am c 24 2010 11: 14AM GERTZ OFFICES 503 692 5433 p . 2 T--- • - Electrical Permit Application - City of Tigard Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: Wattr:;:j.g0tAlgifeeeetW Fee for all residential systems combined $75.00 Check Type of Work Involved: g Audio and Stereo Systems* el Burglar Alarm . 1 Garage Door Opener* 1 :4 Heating, Ventilation and Air Conditioning System* J' cm/ V acu um Systems* Other '.:400#4.,1004St Fee for en,ch commercial $75.00 . • system (SEE OAR 918-309-0000) Check Type of Work Involved: 0 Audio and Stereo Systems 0 Boiler Controls 0 Clock Systems El Data Telecommunication Installation El Fire Alarm Installation • El HVAC 0 Instrumentation • ID Intercom and Paging Systems • D Landscape Irrigation Control* 0 Medical . El Nurse Calls . El Outdoor Landscape Lighting* • • [] Protective Signaling . . . .. 1::1 Other .. . • • Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations 1:113uildinePennits\ELOTacnitApp.doc 07/01/10 • Building Division .. : . q One & Two- Family Dwelling • :r'rcARp Fees Checklist PERMIT ;INEORMATIONi Permit #: MS -6300/3 Plan #: Date: Site Address: /38 7 30i) y/a /c on o -4 ; ce Parcel #: Subdivision: hP✓fe „, Edge u , Lot #: g Zoning: Jurisdiction: T, 5 Setbacks: Front: ,RG Rear: /5 Left: 5 Right: .3 Class of Work: y►yfPu..) Stories: ;Z First Floor: / fe Type of Use: 5F Height: 2 c/ ' Second Floor: / 6 5 ft Construction: IT23 Floor Load: .5.6 (75 — .c Third Floor: -63 Occupancy Group: p_3 Dwelling Units: / 1 Bonus Room: -,z9 Valuation: jr y o j , /A Bedrooms: 9 Total Floors: 3 f rt Bathrooms: 3 Basement: -E-- Decks: 8 Garage: `75 < / to Porches: 3c/ f Other• P icy 1. /8 ' ' ' Fee Amount Airiounf,Paid •` :,. Bala Due . FE �: D �' ; :. , .: <. Plan Check: Building: . / '- . / f ` so . oc , • % . // Extra Set: ' l .,l/4 ti4- N,- Permit: Building: - 35 3-. 0' Jr /, - - q57-.0? Tax: 02/0- 8.5 • SS Metro CET: 3se. Go 3s5. n l) School CET: Mechanical j ,. I . 26 / 2 / 2,D Tax: /Y . 5c/ /y Plumbing: 3 - a , 06 Tax: L .00 C/ 00 Electrical: ' Z38..75 . .75 2 75 Tax: , 33. 4'5 33 • c/S Low Voltage: `4-5 GYM -- S. 00 Tax: c i . 0 0 q.00 CDC: CDC Ping. Rev.: !/C . 00 L/i, CO CDC LRP Fee: (7- 00 CO SDC: Parks: /�j/,2 , CO 1 /8(.2.00 TIF Res.: kSCO . oi' M _ 00 TIF MT: 2,ZC) . pp 40 Erosion Permit: /1.2 , 0 // 2 .00 Erosion CWS: ✓6 . yp ' (140 Erosion COT: f 36. c/o ,1 - 4' ---.v q D(, C. / Water Quality: e°',-- e°',-- ,......:0- - Water Quantity: .0" SUB TOTAL: p /3,295 55 ,$' /25, 57 Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: I: \ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 1 PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment /systems) Description I Qty. I Fee(ea.) I Total Description Qty Fee(ea.) Total . New • 1- &.2- famtly'dwellings •: ' • • Heating/Cooling . , •:• (inciudes400 ft'for each utility -connection)" , Air conditioning or heat pump* 14.00 SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) / 14.00 SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) 17.90 SFR (3) bath / 399.00 Gas heat pump 14.00 Each additional bath/kitchen 45.00 Duct work 10.00 Rain Drain, single family dwelling 65.25 Hydronic hot water system 14.00 Fire sprinkler - sq. ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric) Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00 ` `.Site•Utilities , .: Flue /vent (for any of above) / 6.80 Catch basin /area drain 16.60 Repair units 12.15 Drywell /leach line /trench drain 16.60 Other Fuel Appliances Footing drain - I 100' 55.00 Water heater I 10.00 Footing drain - each additional 100' 46.40 Gas fireplace / 10.00 Manufactured home utilities 110.00 Flue vent (water heater /gas fireplace) 2 10.00 Manholes 16.60 Log lighter (gas) ' 10.00 Rain drain connector 16.60 Wood/Pellet stove 10.00 Sanitary sewer - 1 100' 55.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 Sanitary sewer St each additional 100' 46.40 Other: 10.00 Storm sewer - 1 100' i 55.00 Environmental Exhaust & Ventilation • Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment I 10.00 Water service - 1 100' I 55.00 Water service - each additional 100' 46.40 Clothes dryer exhaust / 10.00 . ' ' : Fixture or.Item - • • Single duct exhaust • Absorption valve 16.60 (bathrooms, toilet compartments, Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer / 16.60 Other: 10.00 Dishwasher 1 16.60 Fuel Piping • Drinking fountain 16.60 * *($5.40 for first 4, $1.00 each additional) Ejectors /sump 16.60 Gas h ea t etc. / ** Gas heat pump ** Expansion tank 16.60 Wall /suspended /unit heater ** Fixture /sewer cap 16.60 Water heater / ** Floor drain /floor sink/hub 16.60 Fireplace • / ** Garbage disposal / 16.60 Range / ** Hose bib 2 16.60 BBQ / ** Ice maker / 16.60 Clothes dryer (gas) ** Interceptor /grease trap 16.60 Other: ** Primer 16.60 Total: Roof drain (commercial) 16.60 Mechanical Permit Fees - Sink/basin /lavatory 1 /p 3 s - 7- 16.60 Subtotal: $ / , AO Tub /shower /shower pan 2 c / / 3 16.60 Minimum Permit Fee $72.50 $ Urinal 16.60 Plan Review Fee (25% of Permit Fee) $ / 5 Water closet 3 16.60 " State Surcharge (12% of Permit Fee) $ Water heater I 16.60 TOTAL PERMIT FEE $ Other: Other: • .. „Plumbin �Permit'Fees ELECTRICAL FEES (residential single- or multi- family) Subtotal $ 39 Description Qty. , Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less / 145.15 4 Plan Review (25% of Permit Fee) $ 4 /7. eg Ea. add'l 500 sq. ft. or portion 4 1 33.40 1 State Surcharge (12% of Permit Fee) $ Limited energy, residential J 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling, service and /or feeder 90.90 2 Electrical Permit - ., v . Subtotal: $ 353 ..."4-5 Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ y, 4 /5 TOTAL PERMIT FEE $ I: \Buil ding \Forms \ResPlanCheckFees.doc 01/19/07 Page 2 • /t. 1 - E 1 . } 0 e / Y yy�� U' i / � ` V RECEIVED 0 J_ x >..i Elev 210 61.81 DEC 2 8 2010 CITY J�� *y Elev 210 wr m•..yq CI1 d� Oi i . / p ' G ER Tz COM IT C N BUILDING DIVI',ION BUILDING 1:' ; t :::::A=1:: ,fir: CUSTOM HOMES SINCE 1977 - ,All (503) 692 -3390 LOT 6 o ,..id co 13874 SW Halcyon Terrace 5 00 g , 31 S Q F T °' Lot 6 Gertz Homes at Edgewood „ . "' ' '� SCALE 1" = 20' } • •• • . - TREE. FENCE . .-.:-.12.::' i PLO PLAN 4 /8 /08 FROM 'CENTE' � + ;. a : ' , ' Elev 212 ' ' • OF TREE • ` ] �\ ' j GERTZ CONSTRUCTION COMPANY INC. �~ ,o ■ ......... WARN ANG RIOR TO ANY /** �� I EXCAVATION Elev 214.5 woo i 5.55 . Ili C1) mx,w o f a r 31 G R��s e N - - MARTI id ' a = • co T 5.082 (rIt. "�' I O 1 c OI ' 'I /./ ft) +za a ro o /. l 1 r z CAR _ 1 I t- iig Elev 214 Elev 214 �"""'��' I ; i� Walter H. Knapp c•7 Certified Forester, SAT' 406 _ I Certified 4rborist, / 4 P,V -0 /97;4 r I FOYER OF ' Certified Tree Risk Assessor. L' • °I1'.." ill _� \ DEN , - .- . i • MIIII 5.00 ,l a. -, Gravel Drive for Erosion ..t '. • SW HAL o.A , CY ®N o . �RRACE �� HOME SQUARE FOOTAGE ' MAIN FLOOR =1437 SQ.FT. Elev 216 58.55 ` Elev 216 UPPER FLOOR = 1650 SQ. FT. TOTAL = 3087 SQ. FT. GARAGE = 650 SQ.FT. /' WM, 1611 CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: L 4ir O 'ODO( j PLANNING DIVISION: • Required Setbacks: D Approved.. ❑ Not Approved Side: S Street Side: Front. _ Ga - t��e ,)O Rear: /i Visual Clearance: ' oved ❑ Not Approved Maximum Building Height CWS Service Provider I..eti-F-r required: ❑ Yes (/No ��� L1 R ece ved B) : 5 . Date: J? /a? / TO ENGINEERIN tL Ot DEPARTMENT: Actual Tope: % Approved ❑ Not Approved Site P an: ff Approved ❑ t Approved By: Date: / Z 2- 7 Notes: c a4--etz..4 a-a -Le CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: . Street Trees: 113 proved ❑ Not Approved Protected Trees :1 1� O Approved t . Q N • t Ap roved . B): /0/ a/V Date: 3fa2ll Notes: P; y .. Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: r 000 ( 3 Jurisdiction: Site Address: /3 7 , �. 7 Subdivision/Lot #: and /or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned /building have been installed with compact or linear fluorescent, or a lighting source that has a ninimum_eff cacrof 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: - -- Date: - z2 Owner /General Contractor /Authorized Agent t Print Name: 601) ORSC Section N 1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 ____ L c ) 1A 1= ---- — A_ F14449 — co•-e-c__ eit-A--- & i ,ziogreiL-k— - - c-tmA- r•• Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, Z' , am the general contractor or the owner- builder at the following address: Site Address: (3 /7 y 1 ,, 2 City: ', • Permit #: ePa -.. 49 ®4.3 • Subdivision/Lot #: and /or Map and Tax Lot #: To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes,-the building • —__` official shall be notified in writing by the general contractor that all moisture- sensitive wood framing members used in construction have a moisture content'of not more than 19 - percent by dry weight of dry framing members. r Signature: r _ Date: ��g�ti General Contractor or Owner - Builder 1:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION ,x r - Owner/ agent for (PLEASE PRINI) (PERMIT HOT DER) _ . ' - - - • do here4 certih that the fogring,:focation meets ; ; • ',16' City of Tigarctland Use and de$/opMely standards for street _tree installation whir consistent ,with the approved - Site plan. SITE ADDRESS: /3 7 L .5 SUBDIVISION: 4 ei4 , LOT #: , SIGNATURE: DATE: (OWNER/AGENT) RE CEIVED VERIFIED BY: DATE: (CTIY OF TIGARD) Tree location verified per approved site plan. I: \Building \ Forrns \ StreetTreeCertificate 07/01/2010 RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: 19257 -- �J d Site Address: /3 e 7 ./ , Sw jla /c Y Te (re, ce Subdivision: re r4 a' 1/ j»7 G edge co CJ Lot No.: ‘• Contact Name: e l4 er Business: F e (co 5/ c is H ( • .74c. Street: /9200 St j Ave City: fjir,, /si /1 State: Zip: 9e.)‘-‘,7, g 7 ?0, As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or " complex" as defined in ORS 455.467 and 455.469. The application is complete. n The application is incomplete for the following reason: ❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. ❑ The submitted plans cannot be reviewed until the above information has been submitted and /or approved. ❑ The plans are deemed "simple ". The plans are deemed "complex ". Signature: Name: Brandon Shaw Date Tide: Plans Examiner Phone: 503 - 718 -2425 E -Mail: BrandonS @tigard - or.gov ]: \ Building \ Forms \RES- Permi[AppRevw- Blank.doc 1/18/07