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Permit /, • EXPIRED ►/�ZPi° toe/ 7 Building Permit Application � � FOR OFFICE USE ONLY h PP 1: �� Received City of Tigard DateB : / i • Au Permit No.:/kl L'_ Jr. ^ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��� Phone: 503.639.4171 Fax: 503.598.1960 4II 1'` Date/B : 1� Other Permit:C fed7�J�, U Inspection Line: 503.639.4175 Date ReadyBy: r�„/Op ("1 �uris: ® See Attached Checklist for Internet: www.ci.tigard onus , Notified Method: ( it/ O IL M-9 Supplemental Information TYPE OF WORK REQUIRED DATA I-AND 2-FAMILY DWELLING El New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rou nded to the nearest dollar)of all ❑Addition/alteration/re placement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ (�`"' vl5O m N 1-and 2-family dwelling ❑Commercial/industrial �� 1 ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address: r 16b065.07 p j'1Cf LD � New dwelling area: 2 square feet City/State/ZIP: '1 (r ti 0� 01 1 a,' 4 Garage/carport area: (p/ square feet Suite/bldg./apt.no.: 1 Project name: 'la V ,S Covered porch area: 20 square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: ---ViQ,11.a. \h5-kCk Lot no.: 20 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and t he profit for the " �„, DESCRIPTION OF WORK / J work indicated on this application. p't 1. 55U f. 7 \/ e , 192,{ /4 vi5 74 Valuation: $ • Existing building area: square feet ,►i C)T 7vO( —`b0(40 New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: I.'.1 N r it 1 uJ C I Y t'l.t._ a ,")r • Type of construction: Address: I Li Z'5 Ni A-r b' -r tI L.-v __ IS/t,w r- 4 2 G( Occupancy groups: City/State/ZIP: f')C4v et--c'L Cr- e 7 C C) (43 1 Existing: Phone:(5/.ti ) (; 5 - C`7 b , Fax:(j1'-?5) 6oCj1, _ 24:"/L(z New: Business name: j7__,v.y 51 cl, H --(s 5 -, �—.• All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board C Ci,]r'YI AA .t.i.- under ORS 701 and may be required to be licensed in the Address: 1 C 5 ? jurisdiction in which work is being performed.If the 12 S /V W (-,-c rite,,, �✓i.wv( .?v;ft`- ._C(,; J gP City/State/ZIP:/State/ZIP: G' ) applicant is exempt from licensing,the following reasons h h r"t✓el.-4. �yL a 17 C C(,% apply: PP Y: Phone:(4✓G3) L f 5 -U�1 e,G. l Fax::( e..5)(y�G 7 4.2 E-mail: (t "ylC.{ ,i r i✓ , ..'C.i- •)- 'el "m ,a. E ;I¢ t, x 0. ti,1 :,,', ,at;, K,�vX lilA -,,,,: ! b y Business name: II,v4,I'`�l C;i.-e f icyvZ.. -17-V1C_ BUILDING PERMIT FEES* Address: 11 2 5 N Iv A-hl r.:).e,y L T,. P :LA ()(,,i k 2C C.) Please refer to fee schedule. City/State/ZIP: !l'G..V,G't*-YL 0 e ! 7 i;'( (>` Fees due upon application Phone:(c0) ) (P Lt 5 -Gel �,(C Fax:(t✓72,) 47`-i t.- 2 4t Amount received CCB lic.: Date received: Authorized signature: , 16 r�2� C P< ' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ,,t.t-561)1-- A-{ Date: 12 Z 0_ (Al * Fee methodology set by Tri-County Building Industry i Service Board. I:\Building\Permits\BUP-PamitApp.doc 12/03 440-4613T(11/02/COM/WEB) . Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard Received 3 /'-13� Permit No.: M5-1--(100r......�r Yf�'7 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: W 1i�,� Phone: 503.639.4171 Fax: 503.598.1960 Plan Review `� Date/By: Other Permit No.: 24-Hour Inspection Line: 503.639.4175 ,J14 i 1 I Juris: Date Ready/By: See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE X New construction ❑Demolition For special information use checklist. Description Qty. I Ea. 1 Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 a 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00 ❑Accessory building El Multi-family SFR(3)bath I 399.00 R Each additional bath/kitchen 45.00 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB:SITE INFORMATION AND LOCATION Site utilities Job site address: /S.1(0 5 NS n" /2 1 pK'X 4 E/( ti- Catch basin or area drain 16.60 City/State/ZIP:""Cl 9a� D. °l1 )44 Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: y I Project name: \\a J,STS. Footing drain(no.linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: Ira V 1.65 I Lot no.: 0?) Water service(no.linear ft.: ) Page 2 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer , Page 2 34 2 Backwater valve 16.60 Clothes washer I 16.60 16.(o(2 Dishwasher i 16.60 I(f,.(O ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: l:.l the./Y-'-;)[,(.L M.:YI'tP41 TYX • Expansion tank 16.60 Address: L 7 fit/ t-.�-i� Fixture/sewer cap 16.60 14 5 W ,�m her�l.er.�, �� J ;F 7 c-c; p City/State/ZIP: 100 J Floor drain/floor sink/hub 16.60 jz,y Phone:(5�)) d� ce Fax (5c"ij) 19.'10 2-q<1 Z Garbage disposal I 16.60 (� �.a. 3 Hose bib S 16.60 Y�. € n t fit i eP ]#1 t Ice maker i 16.60 [/ (?,L,0 Business name: 12_,T v cL `, f Xr/C-• Interceptor/grease trap 16.60 Contact name: At ( C--yt.- t Medical gas(value:$ ) Page 2 17 g Address: (CI 7 5 No/ /4t►� 2rn i t it.“)i_� Pr 700 Primer 16.60 City/State/ZIP: Roof drain(commercial) 16.60 Phone:( ) I Fes..( ) Sink/basin/lavatory 16.60 Tub/shower/shower pan 16.60 J(: E-mail: Urinal 16.60 /r( o r ;�F. . Water closet I 16.60 �(y,(G(� Business name: J�if()mien I 1-1(1C �''`� Y"5 Water heater I 16.60 /(c t Address: 2 S Oc .Cj•t.,,. A Lie)t,54._ ti • Other. City/State/ZIP: U,1 h 0 C)7006 Subtotal (f rii q C- Minimum permit fee: $72.50 Phone:(5-43 ) Qcii-b 6S 7 Fax:(,03 ) 27 Z- 95413 Residential backflow minimum permit fee: $36.25 Plan review (25%of permit fee) CCB Lic.: (�{Z (� I Plumbing Lic.no.: �j y- 370 p�j � t > Authorized signatures G sail State surcharge(8%of permit fee) an TOTAL PERMIT FEE 3f Print name: .30ii,t 4 h 8 r I I Date:2-e__ d j This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i:\Building\Pemits\PLM-PamitApp.doc 12/03 440-46i6T(10/02/COM/WEB) X33 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received / g� Permit No.. m5T/l,]5 g Date/By: '✓i v t/�/`� (]�� 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review - Lmper I I Date/By: Other Permit: Inspection Line: 503.639.4175 al Date Ready/By: Juns: Internet: www.ci.tigard.or.us - Supplemental See Page 2 for g Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work r.*New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* El I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building Foe cpec;a(;nformar;on use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description P Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: J� { ( / , Air conditioning or heat pump 1 S lv U 5 SrY izzi p/Xt'e \ (/(/, - (requires site plan showing placement) 1 14.00 City/State/ZIP: -1-\5„,„..6 ' Ia l an�- Furnace 100,000 BTU(ducts/vents) 14.00 Suite/bldg./apt.no.: Project name: e`1 Q sko. Furnace 100,000+BTU(ducts/vents) 17.90 V� Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler(radiator or hydronic) 14.00 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 10.00 Subdivision: ?;e Al A V.`S-k`,- 11 Lot no.: 7 C Flue/vent for any of above 10.00 �/`' Other: 10.00 Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 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 ❑ PROPERTY OWNER Chimney/liner/flue/vent 10.00 ❑ TENANT Other: 1000 Name: Li'' t e -JiL.L 1fc)-vi,.; , -l ),_,,C Environmental exhaust and ventilation Address: I," ZU Range hood/other kitchen I 17 5 /`l LEI 467),-)'Y7r;Tr'Y 1 �. pj�t�(,L�L� equipment 10.00 City/State/ZIP: rJ c co V,e - 02 '7 t'U Clothes dryer exhaust ( 10.00 Single-duct exhaust(bathrooms, Phone:(�C1'') L :._, H, • " r,,1 , Fax:(5[)-rt. ) (' c;c .' ?-/rt7 toilet compartments,utility rooms) 3 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 -) Other: 10.00 Business name: j i y .c.:„I, /(-,Le f ICr wel5, .:7-----i.--)C: - Fuel piping - Contact name: A L tt`cM Ait�,i,i____ $5.40 for first four;$1.00 for each additional Address: urnace,etc. y 2 S Al v(/ ->» r /I)r*i✓w 1 # 2 c b Gas heat pump City/State/ZIP: L/C 1,t ve, -�ryL; (912_ q?0 0(47 Wall/suspended/unit heater Phone:(Sly?)) 40:(4 5- e/ (e Fax::(g.)-3) 0 L-2 ei L4 7 Water heater Fireplace E-mail: am,,,,,--6)r I ✓e46,,,,tx_ 1 c'w -C tY .- Range ,1 CONTRACTOR Barbecue Business name: 111 - M Clothes dryer(gas) l 11.. T a ,a-.� .,n :� r C. ; Other: Address: .7 M-.� 12 73 . t S-t 0 k)t t,' c_.-- ' _ :,W MECHANICAL PERMIT FEES* 1 City/State/ZIP: J.�c L._^ , 5k_ c;,1, 6 T. Subtotal ' ., Phone:((-e 3 ) Fax;(3"z ) <; Minimum permit fee($72.50) r 3 K 4 - Y> + `� - S Plan review(25%of permit fee) CCB lic.: /•j 7 n 3 } State surcharge(8%of permit fee) TOTAL PERMIT FEE 0.(4.0 Authorized signature: ms--4.--)„..-- This permit application expires if a permit is not obtained within 180..-a .____.-- I days after it has been accepted as complete. Print name: ' J+' Date: t-c f r, 1 b r " Fee methodology set by Tri-County Building Industry Service Board a-.l'_. f_'�a 11 i:\Building\Permits\MEC-PermitApp.doc 12/03 440-46177(I1/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Date/B : APIr /3, Permit No.:f7]STi,4 _ r — / _ .4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit: Inspection Line: 503.639.4175 . &Ill Date ReadyBy: Juris• ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW E New construction ❑Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other DService over 225 amps,comm'l ❑Hazardous location ❑Service over 320 amps-rating ❑Buildng over 10,000 sq.ft., CATEGORY OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential © 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi-family ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders,400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: /64)d 5 17/ e `1 phete( Health-care ofp ay ❑ � ` Sub(rtlt 2 sets of plans with any of the above. City/State/ZIP:71 Qt G ) 0 The above are not applicable to temporary construction service. Suite/bldg./apt.no.: J Project name: ��; FEE* SCHEDULE: ��4 S Description Qtr Fee. Total Cross street/directions to job site: New residential single-or multi-family dwelling unit. Includes attached garage. 1,000 sq.ft.or less I 145.15 ' 'j 4 Subdivision: 'e`,\!t N v Lot no.: Zt Ea.add'I 500 sq.ft.or portion y 33.40 701), I Tax map/parcel no.: Limited energy,residential t 75.00 2 Limited energy,non-residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling,service and/or feeder 90.90 2 Services or feeders installation,alteration,and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: Jb V€I'' '').,rA- f--ICYNCL 5 , may, 601 amps to 1,000 amps 240.60 2 Address: G �7 (��� Over 1,000 amps or volts 454.65 2 (Z /�/l�/ `'�rJ-` '` ��1't l(_ "�� # -- Reconnect only 66.85 2 City/State/ZIP: /3e ctV•ey 1-G y Li 4'i-700(i Temporary services or feeders installation,alteration,and/or relocation Phone: (SP,) (pt.¢G✓ _ 0 6/f.Uj Fax:(&,"."..5) (o C:-- ?i 4 Z 200 amps or less 66.85 1 Owner installation:This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel ❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with service or feeder fee,each Business name: IL• �fXti 1{),P H o c Tvic branch circuit 6.65 2 B.Fee for branch circuits Contact name: . .L (5<r,\,4 AA(...4 t I without service or feeder fee, 2 Address: c �yy ��`` each branch circuit 46.85 _ 1 ��'S /�,�11/ [� Lc�I.t� Nt,f,U i � ?C'�•' Each add'1 branch circuit 6.65 _ City/State/ZIP: BetvV.er.IC,,.) . ' -74)0(e)--) Miscellaneous(service or feeder not included) Phone:( � ) Le t.#5.--_-,0 (u Fax: :( c3) 9 7 e 7 Pump or irrigation circle 53.40 2 1 t-� Sign or outline lighting _ 53.40 2 E-mail: ��c.-/yIci. r j v‘47 -ter r f ic,:yt o , C c'wk Signal circuit(s)or limited- CONTRACTOR CONTRACTOR energy panel,alteration,or extension.Describe: Page 2 2 Business name: L�Ovr 0'(e.C�r�r.-C G _ Each additional inspection over allowable in any of the above Address- P Q 6 Q24 3 R Iy Per inspection 62.50 City/State/ZIP: .Q O _tc.( 0 r. Investigation per hour(t hr min) 62.50 1 Industrial plant per hour 73.75 Phone.(S-Z3) 6 S _i 3 S S I Fax:(-0153) 6 Z g —11,0 $ ELECTRICAL PERMIT FEES* CCB Lie.: �e) f i� Electrical Lic,:_2 S/-/O'7c Suprv.Lic.:31 b z 6 Subtotal 3 LS,E 5 Supry Electrician signature,regtrired'7� _B g f?..;O p Plan review(25%of permit fee) State surcharge(8%of permit fee) 7-1 70 Pint name: e rl 2V`'� V /� a 1 Date: Dc- �" 1�`�~Q 2f 7� TOTAL PERMIT FEE ` - Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board - ••Number of inspections per permit allowed. i\Building\Perrnas\ELC-PennitApp.doc 12/03 440-461ST(10/02/COM/WEB 1 Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received/B : •/ Permit No.: /+') , • .- ,, , 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review _,' �"� Date/B : Other Permit: Inspection Line: 503.639.4175 11�� Date Ready/By: Juts: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW - Ek ew construction ❑Addition/alteration/replacement Please check all that apply: El ❑Other: ❑Service over 225 amps,come! ❑Hazardous location ❑Service over 320 amps-rating ❑Buuldng over 10,000 sq.ft., , 1 CATEGORY OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential Eq- -and 2-family dwelling ❑ Commercial/industrial ❑Accessory building y ❑S stem over 600 volts nominal units in one structure ❑Multi-family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders,400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: /6(Qd 5 <YV t y� e,( - ❑Health care facility ❑ � /' Submit 2 sets of plans with any of the above. City/State/ZIP: 1 'j(.)'r 4,6 I c, /, 2_'74, The above are not applicable to temporary construction service.• Suite/bldg./apt.no.: 1/4) { + Project name: �l ` v l SCHEDULE t� Description Qty. Fee. I Total I '* Cross street/directions to job site: New residential single-or multi-family dwelling unit. Includes attached garage. 1,000 sq.ft.or less ' 145.15 i t/c 4 Subdivision: l�l v i s-�t i Lot no.: Zt Ea.add'l 500 sq.ft.or portion (G 33.40 1.L`e, 1 `� Limited energy,residential 75.00 2 Tax map/parcel no.: Limited energy,non-residential 75.00 2 : DESCRIPTION OF"W ORK Each manufactured or modular M1/ ) \ c J l 0 f 2 C(J Y 1 ce-c t dwelling,service and/or feeder 90.90 Services or feeders installation,alteration,and/or relocation 2 �/ 200 amps or less 80.30 2 1d PROPERTY OWNER I -,j 0 TENANT - 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 01.4A73-)ii � } -�M i 5 / iiC , Zc)u 601 amps to 1,000 amps 240.60 2 Address: 2.5 /q /� Ali ar/,, i �f Over 1,000 amps or volts 454.65 2 "I Reconnect only 66.85 2 City/State/ZIP: t vel/ (412_ �° -7 00( Temporary services or feeders installation,alteration,and/or �2,�� relocation Phone:(5(75) GA4.5—i/- C.JI� Fax:(9),) !"-- 0.02_C-1 L f Z 200 amps or less 66.85 I Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel IAPPLICANT _ ❑ CONTACT PERSON ,, A.Fee for branch circuits with service or feeder fee,each Business name: 12) Y.t.V\Y^l. f yyt ) J �c __ branch circuit 6.65 2 Contact name: • J ! 'v / yyyy B.Fee for branch circuits �� - Lf'� ) 7,t t) without service or feeder fee, 2,5- t),IAA,' each branch circuit 46.85 2 Address: I 1 rfc1/- 1 l "�'J/ 1 Each add'1 branch circuit 6.65 2 City/State/ZIP: 64/ ' , '1/ v q /0 O[ Miscellaneous(service or feeder not included) Phone:(g?",)) 67//•-".., Oi S 1 Fax: :(5P))&<-76)—?Gf L� Pump or irrigation circle 5140 2 l Sign or outline lighting 53.40 2 E-mail: Signal circuit(s)or limited- CONTRACTOR - energy panel,alteration,or extension.Describe: + Page 2 2 Business name: C4 VIA/' 1✓� / 1 a Z1 Each additional inspection over allowable in any of the above Address: ref Z '-- m I /�ek ta,1_4 prcil, G City/State/ZIP: I Per inspection 62.50 tY ��� (��j �'��/� C �(� L �% Investigation per hour(1 hr min) — 62.50 1 ` Industrial plant per hour 7175 Phone:( //�7) 5--�� r/,r Fax:( ) �'`/-ZL f Z ELECTRICAL PERMIT FEES* CCB Lic.:1OC(.'s Electrical Lic.: Suprv.Lic.: c c Subtotal �`(�, > > Suprv.Electrician signature,required: Plan review(25%of permit fee) Print name: Date: State surcharge(8%of permit fee) 27. -70 TOTAL PERMIT FEE 377) 2C, Authorized signature: `f i tom'` ) This permit application expires if a permit is not obtained within 180 �� days after it has been accepted as complete Print name: A I i 3 `� l 1l Date: )t . i±t = Fee methodology set by Tri-County Building Industry Service Board •s Number of inspections per pemut allowed. I\BuildinePermits\ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB • Electrical Permit Application - City of Tigard • Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* Burglar Alarm [Garage Door Opener* Heating,Ventilation and Air Conditioning System* Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is Buildmg\Pe mits\FT C-PamitApp.doc 04/03 One- and Two-Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Date/B : 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Associated pemtits: 24-Hour Inspection Line: 503.639.4175 � J ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balancepoints,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- ❑ ❑ ❑ 4,0 basin protection,etc. 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 ❑ ❑ 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. JA 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 'f surface drainage. �L Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. .01-3" 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. 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. -45 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. I.7'" Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 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. ❑ ❑ ❑ Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 27 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 as.licable to the roject under review. .JURISDICTIONAL SPECIFICS ,2" Five(5)site plans a r e required f o r Item 11 above. Site plans must be 8-1/2"x 1 1"or 1 1"x 17". ❑ ❑ ❑ r24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ , ❑ ❑ ‘23" 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. ❑ ❑ ❑ ,,2'1 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 728 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard Cl ❑ ❑ Street Tree List. .-21)-- Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 39 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits\One-Two-FamilyChecklist.doc 12/03 0 < ?o' - > adI: r :) 114 }►-1' Building Division 1IGARD One & Two-Family Dwelling Fees Checklist PERMIT INFORMATION: '. . ,r Permit#: j 5-,c,,�!., - C C '7 Plan#: N i11:irc1 L }--i3 Date: Li- 13.-c 0 Site Address: \5te, c . ` -,v11,-\c� 1 Lc) • Parcel#: Subdivision: , t �'`15�C1 Lot#: S Zoning: Jurisdiction: .-1- t<< Setbacks: Front: Rear: Left: Right: Class of Work: J AJ ,,`, Stories: .3 First Floor: 1 @ (c `k' Type of Use: j y=- Height: Second Floor: 1 7 Construction: Floor Load: Third Floor: 13 Occupancy Group: Dwelling Units: Bonus Room: Valuation: ( .0 ` ,(e3Bedrooms: S Total Floors: 3t` 7 4 ! Bathrooms: -J Basement: - Decks: 1(y 6 Garage: ; ; Porches: ( 5 Other: FEES: . Description: ; , Fee:'Amount: Amount Paid: Balance Duet.':.. ` Plan Check: Building: ( C) .(r,9 7 r]C , ( (r. L e9, G9 Extra Set: Permit: Building: , Tax: i •"j Metro CET: ?j ..1 School CET: . !Y. Mechanical ' , -.) (5 Tax: I , , Plumbing: ° 9 . 1 0 Tax: Electrical: . Tax: (.�,5 , y 7 Low Voltage: -7 . C Tax: 6. CC: CDC: CDC Ping. Rev.: 0(; CDC LRP Fee: L is , 00 SDC: Parks: rJ a 1 •O() TIF Res.: "?):).e('-, . co TIF MT: ,;j V, • O) Erosion Permit: 1 l . 0 C\ Erosion CWS: j((. 4 C) Erosion COT: q '-ei 0 Water Quality: Water Quantity: `, 0 C SUB-TOTAL: 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 I Qty I Fee(ea.) I Total New 1-&2-family dwellings Heating/Cooling (includes 100 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) l 17.90 SFR(3)bath j 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-l'100' 55.00 Water heater 10.00 Footing drain-each additional 100' 46.40 Gas fireplace t 10.00 Manufactured home utilities 110.00 Flue vent(water heater/gas fireplace) 10.00 Manholes 16.60 Log lighter(gas) 10.00 Wood/Pellet stove 10.00 Rain drain connector 16.60 Wood fireplace/insert 10.00 Sanitary sewer- l'100' 1 55.00 Chimney/liner/flue/vent 10.00 Sanitary sewer-each additional 100' 46.40 Other: 10.00 Storm sewer-1" 100' jl 55.00 Environmental Exhaust&Ventilation Storm sewer-each additional 100' 46.40 Range hood/other kitchen equipment ( 10.00 Water service-1" 100' 1 55.00 Clothes dryer exhaust 1 10.00 Water service-each additional 100' 46.40 Fixture or Item Single duct exhaust Absorption valve 16.60 (bathrooms,toilet compartments, Li Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic/crawl space fans 10.00 Clothes washer i 16.60 Other: 10.00 Dishwasher 16.60 Fuel Piping **(55.40 for first 4,S1.00 each additional) Drinking fountain 16.60 Furnace,etc. Y ** Ejectors/sump 16.60 Gas heat pump ** Expansion tank 16.60 Wall/suspended/unit heater ** Fixture/sewer cap 16.60 Water heater I ** Floor drain/floor sink/hub 16.60 Fireplace f ** Garbage disposal 1 16.60 Range t ** Hose bib 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 vain 16.60 Subtotal: $ 9'0...SC' Tub/shower/shower pan 16.60 Minimum Permit Fee$72.50 $ Urinal 16.60 Plan Review Fee(25%of Permit Fee) $ Water closet 16.60 State Surcharge(12%of Permit Fee) $ `,L. F, (t- Water heater 16.60 TOTAL PERMIT FEE $ Other: Other: Plumbing Permit Fees ELECTRICAL FEES (residential single-or multi-family) Subtotal $ Description Qty. Fee Total lnsp Minimum Permit Fee$72.50 $ 1,000 sq.ft.or less 145.15 4 Plan Review(25%of Permit Fee) $ Ea.add'l 500 sq.ft.or portion �J 33 .40 l State Surcharge(12%of Permit Fee) $ Limited energy,residential 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling,service and/or feeder 90.90 2 Electrical Permit Fees Subtotal: $ `� i p , q m, Plan review(25%of permit fee)_ $ State surcharge(12%of permit fee) $ y 6,y • TOTAL PERMIT FEE $ I:\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page 2 so, RECEIVED ii'xi n MAR 2 5 2008 ri4b f —iy CITY OF TIGARD BUILDING DIVISION 7?/1714 0 X 1 -?-24 • • tizi;, 41# (2) . '1:C42A— 61111)4 JAI 7 r,q9 4_,rtes / --'1" ) \ ....4. ----, ., 0 3 4. 77 A 0 \. / < / . v, / /1 ' k■ --. . A ■* ----• - / • se A .o / / i Iv. 00'6 I 1 ct) ‘-- , I . s _ At . . / .4).,4 "... i ".... 4 4 %.4.1■7. CV /7 li / e' 3' '44.(ii lk.1 Iti /4!; , q * ::4 tigC7 C) 14 A' ■ 0 .........., ■ At --.. 0 , , SURVEY 05 SW i2 POINT . ■Stp A-p hcbd im. '&V4 IS 03.oz. 21)-('‘v r2-e/v■Tiarl Ili---- frtf.evatece_S i .1 tv._Pec_e---:-.02-3° , ---It -I, A 0 ) v V2 0 7 ' , BELLA VISTA LOT 28 SCALE: 1" = 20' ENGINEERING & LAND SURVEYING (DESIGNED: \ PREPARED FOR: RJ i ri N _.,, 8835 SW Canyon Ln. DRAWN:SW RIVERSIDE HOMES \ Suite 402 . 1925 NW AMBER GLEN PKWY, SUITE 200 i "Irlo,..egaillp Portland, OR 97225 BEAVER TON, OR 97006 .4r CHECKED: (503) 645-0986 --A,.....N.P. T.r RJ (503) 690-2942 3 4 41040, 9 3 (50 ) 291-9398 DATE: 6/20/03.) (Fax) 291-1613 \.... • —....„.. CITY OF TIGARD-SITE PLAN REVIEW illa . BUIL.*!NG PERMIT NO: SW,e7Cenglffaill RECEIVED St Trees: MAR 2 5 10U8 reet 0 Approved 0 Not Approved 6)14A)/ , Protected T 1 : r6 I CITY OF PGARD El : • 01. - Approved lo Not Approved Date , ,, /?,/ 174 BUILDING INVISION cotes: ti/..-,... /-,Q•4 7-4- 4 / . 11.147711t. ;10 t 141411 It V illiiir*:4,' - , 444),k...ilk "(11111tbi Ilp.4 (2) ..c4 .11-- :14' A11111141‘.... 7,7 0411111:1110„,r*-' , .43:• ‘111111 lig, 4-r-t-c s / . ■10--, kil 11111`viewrffl to ri ' • C)) p 4 1 e ..; • , ■tk ,.; A ! ''--• , • , : / 0c) // v. • ., v. . , . r.....„ IP' .. . .-, 6!, f -.. ,........, f/ .AO ili' ,44 ' ?fur) A,9:149Nt , I N,. • 44 j4e. p C / SURVEY 1$40,. \ I, * .■ ■ C/)/,4'*!; , 11 •'''4`.. ? 4 A' ---- ■ 'V ..... --.. 4r - POINT . t5b059,ti P-Ahcbd LA L5101 6 Y OF TIGARD - SITE PLAN REVI NIV f ‘ e. i_ LDNG PEP • ' NO • Yá : .-•• 1' ..------' vi 0 ce...> ------: : -- ---.—__._ , , 1inf`e" PLANN. `...; 1 Not Approved 10 Fr0111. Or C;a:',.12'.. XD Rear: 1-5- Visuai CIe[:;,•::Ice: Ell..A;, )...,_...-, - . .•i Approved i f Maximum lill!ti iqg Height.... . i':.,;;: /I ,CWS Szry , l'i',,,. : ' .;,....,‘. ' :.:P-er Required: Li Yes No ( 0 A 1.1.1"k."--) 0 Igpeo By Date: .. • ENGINEERIN(4E1ART-Ivi ENT: Actual SI pe: % gi Approe,.-1 0 Not Approved .f e Pla , \,... BELLA VISA iteirrnit, Sp?it(..):A"C"ved SCALE: 1" = 20:01 N nu,- ENGINEERING & LAND SURVEYING 6ESIGNED: ...N PREPARED FOR: RJ RIVERSIDE HOMES i 4111", ..)., b 8835 SW Canyon Ln• DRAM: 1925 NW AMBER GLEN PKWY, SUITE 200 Ntv.:„.,,T.c.. ,..\ _tioirtean4d02 OR 97225 ___,(01 klei 0 P tl . OR 9 (0/ S W CHECKED: BEAVERTON, OR 97006 (503) 645-0986 __.....■ 1.1.%÷___ , Inc . RJ (503) 690-2942 DATE: 4 77"4111,kct*".N.,_.... _____ -3 (503) 291-9398 6/20/03 (Fax) 291-1613 RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: MST2008 -000 2 - Site Address: /32 3W 91114. i /,.e', Subdivision: Bella Vista Lot No.: 2s Contact Name: Allison May Business: Riverside Homes Inc. Street: 1925 NW Amberglen Pkwy Suite 200 City: Beaverton State: OR Zip: 97006 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. N.--- The application is complete. 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 ". C- The plans are deemed "complex ". Signature: _____ /ll�' "OE Name: Brandon Shaw Date Tide: Plans Examiner Phone: 503 - 718 -2425 E -Mail: BrandonS @tigard- or.gov T: \Buil ding \Forms \RES- PermitAppRevw- Blank.doc 1 /18/07