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Permit e a) // Z * /pit/mile_ r _c- 0 ,„4/4, I CITY OF TIGARD MASTER PERMIT 1 COMMUNITY DEVELOPMENT Permit #: MST2011 -00159 TIQAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/02/2011 Parcel: 2S104DB02700 Jurisdiction: Tigard . .. Site address: 13111 SW ROCKINGHAM DR Subdivision: AMESBURY HEIGHTS Lot: 27 Project: Pan Project Description: 260 sq ft covered porch addition. Plumbing work removed from scope of work per applicant. 11/30/11, REPRINTED permit to include gas piping for barbecue and fire pit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors' No Total: 0 sf Value: $10,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 -"" Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units' 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add9 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 2 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -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: ALT SF VB R -3 0 Owner: Contractor: PAN, XIANGHUA & GRETCHEN STEINEFMODERN ORGANIC CONSTRUCTION Required Items and Reports (Conditions) 13111 SW ROCKINGHAM DR 4212 NE SUMNER ST TIGARD, OR 97223 PORTLAND, OR 97218 PHONE: PHONE: 503 - 297 -2055 FAX: Total Fees: $588.20 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 through OAR 952 - 001 -0090. You may . • -- - - • .f - . - . :' ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued B '. � _ i _ ��1�� Permittee Signature: ' 0 _ I - 4 - -� . _ ._ Call 5 by 7:00 a.m. for the next available inspection date. This permit card sha .e ept 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. 11/28/2011 14 ;40 5037715579 AIR PRO HTG PAGE 01 Mechanical Permit Application FO R 011. l(' I ISI: t)NI.1 City of Tigard Roc"'. a' 13125 SW Hall Blvd Tigard, OR 97223 Dat / + /ST ���� — QQ/ r .1N , . • II Plan Review Phone: 503.639.4171 Fax: 503.598.196 { / f Date/By: Other Permit! r i (. A r,, t Insp Line: 503.639.4175 Detc Ready/By: ,, • 011 tans: ® See Page 2 for Internet: www.tigard-or.gov 5l,- �j 1 -s Nehfied/method: Supplemental Information } r 1 C I .i' q;,.' .. , ' 7 i ) , ,I 1 i 2 il + , , ( 'Cr. t .,,. Mfr Fb�� � 1 /;G T' _ Q Ncw construction ► Addition /alteration/replacement ec cl permit lbes� me based an the value of the work ❑ Demolition Other: performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor, overhead, and profit. Value: ` ] -and 2- family dwelling ID a Commercial/industrial Accessory building For special ihformatlon use checklist, ❑ Multi - family 0 Master builder ❑ Other: :: ':,:iF 1 ' r rt gri I n T; ;:11';',;', I ! 'Fn ___ Description t ntico Qty. Total ,, � ,� , , ..... . o sun, T,..:r id .;c,' , z .t'. r ,4 h' _ Fleating/COOling Job site address: .3 / ' / - , Air conditionin r ♦ � ., . :� , �rcynirea site fan ahowinp 4lr75 w Fu ace 100 BTU (duct ivtats) 46,75 Suite/bldg. /apt, no.: Project name: Furnace 100,000+ BTU (ducts/vents) 54,91 Heat pump 61.06 Cross street/directions to job site: Duct work 2132 Hydronic hot water system - 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type. not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue/vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances 1 ,. d r ' . :: , :':';';:11',--7,7.7)-V' f I cr.,' t l ; : Water heater 23.32.._ • W. K / Gas fireplace _ 33.39 e * 6 Pluc vent for water heater or gas fireplace 23.32 t.ag lighter (gas) , 23,32 Wood /pellet stove 33.39 € 1 f7' Ad T U ! / - • d Wood fireplace/insert 23.32 rmnc�+ tncr uc /vent 23.32 Other: 2332 'WI I- IIIIIIMIIIII=1 Environmental exhaust and ventilation_ - Address: I — Range hood/other kitchen equipment 33.39 City /State/ZIP: A Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) toilet compartments utili yt rooms) 2132 1� ? i Attic/crawlspacc fans 23:32 Business name: I 4 Other: 2332 ti - Fucipipirttg Contact name: $114.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat .um. City / State/ZIP; Wall /suspended/unit heater Phone: ( ) Water heater Fireplace E-mail: / . . Range ` ` ,r , , � ; � Barbecue Clothes dryer (gas) Business name: �" ,. /� -• • Other Address: tea 0 l City/State/ZIP: v r / 0 , Subtotal Phone: (�43) /- 7 / • - Minimum permit ibe {$90.00) Plan review (25% of permit fcc) CCB lie.: 2,0 8 6 State surchar (12% of permit fcc) — TOTAL PERMIT( FEE Authorized gigrtatuYC: .4.e This permi application expires if permit Is net nhtalned within Did • days after it has been accepted as complete. _ Prat naine: G./ 1C , , t Date: / /— 2 o1— (r " Fcc methodology act by Tri -County Building Industry Service Board , �, CITY OF TIGARD MASTER PERMIT ih ___ I . :'.•: - COMMUNITY DEVELOPMENT Permit #: MST2011 -00159 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 11/02/2011 Parcel: 2S104DB02700 Jurisdiction: Tigard Site address: 13111 SW ROCKINGHAM DR Subdivision: AMESBURY HEIGHTS Lot: 27 Project: Pan Project Description: 260 sq ft covered porch addition Plumbing work removed from scope of work per applicant BUILDING Floor Areas Required Setbacks Required Stories 1 Bedrooms 0 First 0 sf Basement, 0 sf Left 0 Parking Spaces 0 Height 0 Bathrooms 0 Second 0 sf Garage 0 sf Front 0 Smoke Dwelling Units 0 Third 0 sf Right 0 Detectors No Total 0 sf Value $10,000 00 Rear 0 PLUMBING Sinks 0 Water Closets 0 Washing Mach 0 Laundry Trays 0 Rain Drain. 0 Urinals 0 Lavatories 0 Dishwashers 0 Floor Drains 0 Sewer Lines 0 SF Rain 0 Storm Sewer 0 Tubs /Showers 0 Garbage Disp• 0 Water Heaters 0 Water Lines 0 Drains Catch Basins 0 Bckflw Prevntr 0 Footing Drain 0 Ice Maker 0 Hose Bib 0 Backwater Value. 0 Other Fixtures' 0 Drywell- Trench Drain 0 Other Fixture Units MECHANICAL Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0 Heat Pump' N Hoods 0 Other Units 0 Furn <100K 0 Vents, 0 Woodstoves 0 Gas Outlets 1 Furn > =100K 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less 0 0 -200 amp 0 0 -200 amp 0 W/ Svc or Fdr 0 Ea addi 500 sf 0 201 -400 amp. 0 201 -400 amp 0 W/O Svc /Fdr 2 Mfd Home /Feeder /Svc 0 401 -600 amp 0 401 -600 amp 0 601 -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: ALT SF VB R -3 0 Owner: Contractor: PAN, XIANGHUA & GRETCHEN STEINEFMODERN ORGANIC CONSTRUCTION Required Items and Reports (Conditions) 13111 SW ROCKINGHAM DR 4212 NE SUMNER ST TIGARD, OR 97223 PORTLAND, OR 97218 PHONE PHONE 503- 297 -2055 FAX Total Fees: $588.20 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 a • . - • e with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ENTION Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification o ' Those rules ar set forth in OAR 952 -0 -.1 -0010 t rough OAR 952-'41-0 Y ay obtain a copy of the rules or direct questions to OUNC by calling 503 3 • 987 0 1 800 3 234 Issu I By: / / . / Permittee Signature: /r �� 0 Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept 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. Einilding Permit Applicatio Residential FOR, OFFICE USE ONLY City of Tigard SEP 0 8 2011 DateB Ci v `J g ed 9� r ■ Permit N f7 / / /5 , 13125 SW Hall Blvd., Tigard,OR 97 Plan Rem 1 ' Phone: 503.718 2439 Fax• 503 59 OF TIG ARD Date/13 • Eill 0 Other Permit T I G A R D Inspection Line. 503.639.4175 BUILDING DIVISION Date Rea. Ed See Page 2 for Internet: www.tigard -or gov Notified/Method i = j- • �' Supplemental Information TYPE OF WORK S 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: $ X 1- and 2- family dwelling ❑ Commercial /industrial o 1‹.- ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 131' 1 5 vv rip c i vi v� New dwelling area: square feet City /State /ZIP: -TA a kd 0 g 1 27, Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: VA 170 -G,j Aetk4idifl Covered porch area: ,b 0 square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 1 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. 1 AA rjw,,(aon- en&lvscd) and a il[ Valuation: $ Vi f�.t,GG'► GU'P.(dl l4CUl/ Peifio 514. p , , (Jl(a`� Existing building area square feet 'J l New building area: square feet 4 PROPERTY OWNER ❑ TENANT Number of stories: Name: 6 t'- f A 64 + )(tan j VLUGI Fa fri Type of construction: Address: I N 1 5L') 1 — ock ., 1 X WI DIA Occupancy groups: City /State /ZIP: 1 j A 0 ,22- 7 Existing: Phone: ( ) 1 , Fax: ( ) New: EX APPLICANT K CONTACT PERSON BUILDING'PERMITFEES* Business name: co Si-.0 P4 16(y (Please refer tojeeschedule) "1 Structural plan review fee (or deposit): Contact name: Aoiz - jjsj e _ /I DVJ (L I p ,� `� I FLS plan review fee (if applicable): Address: t. 5 � I` t 5 � Total fees due upon application: City /State /ZIP: ` 0 Oe- 1721 r ') f �� 1-12.... I Fax:: ( ) Amount received: / / E r f 7 Phone: ( E -mail: C0(ns ��n1Gt rnsyle tip PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR /} roof -top mounted PhotoVoltaic Solar Pane ystem. Business nam : H ply f. 2 v C - 6 f},0 t en A)S Qv.. _`7O ) Submit t : 2) sets of roof plan with t.nnection details and fire dep., ••ent access, alo ._ ith the 2010 Oregon Address: 2, a E (..A_M 0E2 SolarInstallatron ;�cial 'ode checklist. City /State /ZIP: I L� c a Q 7 � g Permit Fee (inc Ian review $180.00 an.: m r • . Phone: ( J a 4 - Z - 2.. 05 Fax: ( ) State su • arge (12% of permit fee : $21.60 CCB lic.: (.07007 7/24,5 etel-fFafiue upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained /'2 within 180 days after it has been accepted as complete. Print name: Gl a j l 0 - Date: I * Fee methodology set by Tn-County Building Industry Service Board I.\Building\Permits\BUP - RESPermitApp.doc 02/24/2011 440- 4613T(11/02 /COM/WEB) Building Permit Application Checklist . One- and Two- Family Dwelling FOR OFFICE USE ONLY - . ill . City of Tigard Received Date/By No . 'I 13125 SW Hall Blvd., Tigard, OR 97223 6 Phone: 503 718 2439 Fax 503 598 1960 Associated permits TLGARD 24- Hour Inspection Line 503 639 4175 ❑ Electncal ❑ Plumbing ❑Mechanical - , Internet www.tigard -or gov ❑ Other THE FOLLOW ITEMS ARE REQUIRED FOR PLAN REVIEW ] Y.es. No # N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 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 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 Oreton and shall be shown to be a ilicable to the iro'ect under review. JURISDIC SPECIFICS 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. I. \Building \Permits \BUP- RESPemiitApp.doc 02/24/2011 440 4613T(I 1/02 /COM/WEB) Oct 31 11 02:53p All Pro Electric 503.246.0406 p.1 NE '' I ISIAIU DNI1(1 Iles Electrical Permit Appl a n i o n r � �d�LL�O FOR OFFICE 1 SE ONLY City of Tigard OCT 110 31. 2011 t 6 1 Received Ill 17atcB Plan : 13125 SW Hall Blvd., Tigard, OR 97223 Review Phone: 503.71$.2439 ! .r 518I66(l r- I Date/By: Other Permit: TIGARD Inspection Line: 5( ftii i- ����� c `. ; , Ready/By: ]iris: gl See Poge2 for Internet ]vww_ti M� r� G DIVISI "+ i 1 ' , lcd/fvlethod: Supplemental Information I TYPE OF WORK PLAN .RE VIEW . ❑ New construction pa Addition/alteration/replacement Please check all that apply (submit2 sets of plans w /items checked below): ❑ Demolition Q� © Service or feeder 400 amps or more 0 Building over three stories. 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 tn 1 - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building amps forall other 112.5111112I1005. buildings. Multi- family 0 Master builder ❑Other F]re p P• ❑ installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system_ larger separately derived system 0 Addition of new motor bad of ❑ `•A °, "E', °I -2', ' i -3 ", Job no.: Job site address: it'll �{M 1 Six oII' or more. occupancy. f rti ❑ Six or move residential units. ❑ Recreational vehicle parts. City /StatefZlP. . D i. 1l 'i 0 Health -care facilities © Supply voltage for more than ❑ Hazardous locations. 600 volts nominal" SuitefbldgJapt" no.: roject name: - pAt.,1 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I oty. l rem I Tam I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map/parcel no.: Ea. add'! 500 sq. ft. orportion 33 l - Limited energyy, residential 75.00 2 DESCRIPTION OF WORK (with above sq" ft.) Limited energy, multi - family C - L-., MST/VI --- bbIC1 residential (with above sq ft ) 75.00 2 Services or feeders installation, alteration, and/or relocation U W A4MO21.3 0 c„ 200 amps or less 100.70 ` 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1 amps 301.04 2 Address: Over 1,000 amps or volts 1 j 55226 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 i intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT Q CONTACT PERSON above service or feeder fee, 7A2 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'! branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each 67.84 2 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 Ir � Signal circuit(s) or limited-energy Business name: All T K �"'r� t t �� panel, alteration or extension. Page 2 _ 2 Each additional inspection over allowable in any of the abov Address: Additional inspection (I hr min) I 4'M , �L LP so) C + �L.... tt Cu r T'�- 66.25! hr ,-- City/State/ZIP: TO 121-0/03 t> , d a_ o '1?vq Investigation (1 hr min) 66.251 hr o` Industrial plant (1 hr min) 78.18/ hr Phone: (3) r t Q Fax:? „..4.( 0Ljy�( Inspections for which no fee Is 90.00/ to v w specifically listed CA hrmin) CCB Lie.: LtK 10 Electrical Lie.: IC 0 1. , G Suprv. Lie_: 0 S ELECTRICAL PERMIT FEES ��qq � - if i ' Suprv. Electrician si rs 611 lequired: J (,U / t 1 3 Subtotal: Plan review (25% of perm tt fee): Print name: ice, t14 O LL, Date: tDI er / fii State surcharge (12% ofpemtit fee): Authorized signarure: �' r TOTAL PERMIT FEE: y This permit application expires if a permit is not obtained within 180 Date: J days after it has been accepted as complete. Print name: Sr i WI ?o 0 � : i0/ t3I I t ' Number of inspections allowed per permit T:lauildiugWvmitstELC-Perm,tApp (loc. 07/01/10 440- tatsr(I ]i05tCOht'WEB Mechanical Permit Applicatio RECEIVED FOR OFFICE USE ONLY Ili City of Tigard Dateived 7 e G /� Permit No f 5� 'r 13125 SW Hall Blvd , Tigard, OR 97223 SEP 08 2011 � / � - � D / C Plan Review Other Permit: Phone: 503.718.2439 Fax. 503 598.1960 Date/By TIGAKD Inspection Line 503.639.4175 CITY OFTIGARD Date Ready /By ions See Page 2 for Internet: www.tigard- or.gov BUILDING MINNTON Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE" SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New constructionddition /alteration/replacement performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit Value $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: ( 3(I � 5W 12-0 vtf ��� 1) v (requires site plan showing placement) 46 75 City/State/ZIP: -- p ) , Furnace 100,000 BTU (ducts /vents) 46.75 Cit y - 1 { AAy Q } 1 �j Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg./apt. no : L Project name: 12 'F (� r cI b 61 Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23 32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46 75 Subdivision: Lot no.. Flue /vent for any of above 23 32 Other. 23 32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23 32 Du j I Gas fireplace 33.39 (Ov i 1N�Ot!IL� 0 v-ev , AG7v t V � Flue vent for water heater or gas 4 fireplace 23.32 Log lighter (gas) 23 32 Wood/pellet stove 33 39 Wood fireplace /insert 23 32 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23 32 Name: Environmental exhaust and ventilation: Address: Range hood /other kitchen equipment 33 39 City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax. ( ) toilet compartments, utility rooms) 23.32 g APPLICANT CONTACT PERSON Attic /crawlspace fans 23.32 Business name: / ! Other 23.32 Gt�N S (4.- � s T i Fuel piping: Contact name: i -Q lpi Floe ei00otN/ 1 $14.15 for first four; $4.03 for each additional Address: ? 7? 5W M-Y-0 Sr Furnace, etc Gas heat pump City /State /ZIP: byt 1,,,._ 41 Zj ' Wall /suspended/unit heater Phone: ( 3 /511 Fax: : ( ) Water heater Fireplace - E -mail: GDh.fh g msh ..4,-04,-) Range ( - 'CONTRACTOR Barbecue Business name: 1„ert..,_ l Pc-u. H $ ( N 4, Clothes dryer (gas) Other. Address: g CO . -t..) 1,0-1 t ' 4"r MECHANICAL PERMIT FEES* CDC City/State/ZIP: P r i.,_ D 2 Q7 2-95 Subtotal 0119 Phone: ) ,. c Fax: ( ) Minimum permit fee ($90.00) L / -�-- 3 �12 O g Plan review (25% of permit fee) CCB lie.: ( , 4 �� I „� State surcharge (12% of permit fee) id , g 0 `(' f F r TOTAL PERMIT FEE /0(9 . ?Z.) This permit application expires if a permit is not obtained within 180 Authorized signat re: days after it has been accepted as complete. Print name: a(h 6 6Poolvvi i A Date: 1 f/i i ' * Fee methodology set by Tn- County Building Industry Service Board 1 \ Building \ Permits \MEC- PermiiApp doc 09/09/10 440 -4617T (I I /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 first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I \BuildingTennits\MEC- PennitApp doc 09/09/10 2 Plumbing Permit Application r� Building FixtD/. "s RECEIVE . FOR OFFICE USE ONLY City of Tigard Received �, ! /LS—D S E P 0 8 DateB . .4 11 Y Plan Review 'emit No 'I 13125 SW Hall Blvd., Tigard,OR 97223 201 / M Phone 503.718.2439 Fax 503 598 1960 Date/By. Other Permit No.. T l G A R D Inspection Line 503 639 4175 CITY OF TIGARD Date Ready/By. lures ® See Page 2 for Internet. www tigard- or.gov BUILDING DIVISIO • Notified/Method Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. Ea I Total raAddition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 01- 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: t Catch bas .0 oc a drain 18.76 1 3 1 / s W ko ii _ A� 0 �� jiAin .4i V' ._ Veil, leach line, or tench drain 18.76 , City /State /ZIP: l � 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 Rain drain co'' -ctor \ 18.76 S. itary : . • (no linear ft • Page 2 r torm sewe\ no linear ft ) 1 Page 2 W t- a (no linear ft: ) I Page 2 / ■ Subdivision: Lot . o.: �� tui r tem: OM Tax map /parcel no.: �.� • 1_ 31 27 iii� DESCRIPTION OF WORK V' '�1 12 51 Clothe washer 1 IF 1 1 25 02 P h✓ mbl frt5 - d ra-(l Ar 11-41) 51 " I Dishwasher 25 02 J 1 inking fountain 25 02 Ej. ctors /sump �F I 25 02 /i PROPERTY OWNER ❑ TENAr' E. .ansion �k VVVV Ail 12 Name: I txture /sewer V 25 02 ■ A ' • J A- ! A ' Floor drain/ 1 to si!'4i b 25 02 Address: 1I S y i; „,, / Jai. �I e- Garbage disp �31 N1� 25 02 City /State /ZIP: 7 ri " r / off-- �I 'lit , Hose bib 25 02 Phone: ( ) ( ' U /"_ Fax: ( ) Ice make l 12 51 F.1 APPLICANT 41 CO ACT PERSO1M Interce a : grease trap I 25 02 Business name: to � �' p Medical (value. $ ) Page 2 ' N Contact name: i fL 114 E • 00 (Vi 0 Primer 12 51 -,�� Roo ra, - (commercial) / 12 51 Address: - 20 S ' ‘, Ai r 1 ��'-■ FNMA lavatory / 25.02 City/State /ZIP: POY N OP- vl i 1 • (potable water) 62 54 Phone: (5b) 5 iv i1512__- Fax: : ( ) T /sh i wer /shower pan / 12 51 E -mail: l iron „ a final 25.02 // 111 1 iONTRACTOR .te closet / 25.02 Water heater 37 52 Business name: iae, 1 Water piping/DWV 56 29 Address: ' Other: 25 02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Li no : Plan review (25% of permit fee) State surcharge (12% of permit fee) 1,,■ Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days f% after it has been accepted as complete. *Fee methodology set by Tn- County Building Industry Service Board I \Buildmg\Permns\PLMU- PermitApp doe 10/01/09 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 50.03 0 to 2,000 $121 90 - Footing drain - each additional 100' 37 52 2,001 to 3,600 $169 69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37 52 Water Service - 1st 100' 62 54 Medical Gas Systems: Water Service - each additional 100' 37 52 Valuation: Permit Fee: Storm & Rain Drain - Ist 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 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 ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. Drive Thru ❑ New exterior plumbing site utihties for any complex structure Cuspidor/Water Aspirator as defined in OAR918 780 - 0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Anycomplex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" 4 Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic—non -food s g q g Disposal - Domestic—food related that meet the qualifications above. - Commercial —food related - Industrial -food related Ice Mach /Refng Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures I:A Building \Permits\PLMF - PermitApp.doc 02/24/2011 2 11 q Building Division Development Code Provision Review TLGARD Residential Projects Building Permit No: /VS // - 067 9 �] CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑ Routed Plans: Original Plan Submittal Date: 9/F-// 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (V) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact L )Cw1/J te' #f at 503- 718- „2 - 1 09 or , J0G1r9, / @tigard - or.gov) Land Use Case No. Name D le Y, S Cr Setbacks: Front / Rear Side S Street Side I S J Garage old El” Maximum Building Height 3" Actual Building Height ❑ Visual Clearance Easements 1€' it Ude. I Sensitive Lands Type: S1',3 Notes: Original Plan: Approved Not Approved ❑ Date: ll Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) ,Actual Slope: Notes: 3 4-6 PC 1 /3 ?FA -(L. Sze / / Original Plan: Approved Not Approved ❑ Date: q // Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503-718-2700 or todd@tigard-or.gov) In Trees d Protected Trees Notes: Original Plan: Approved / Not Approved ❑ Date: 7 /�y /�c7 /1 .. ln pp pp ` i Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Ap ''cant Okay to Issue Permit: Yes No ❑ Date Routed to Building: _ I!/ C Page 2 of 2 . ., .4,-, . . i I H 7 p7ol /-Dl.S9 i r, m licn , SEP 1 3 2011 T, ` \E, CITY OF T6 � 10 Clean Water Services File Number SEP 0 9 2011 C PULPING a e r ' Services I i 1 OV 3 30 __Sensitive Area Pre - Screening Site Assessment d i c iionon: e,1 w_� .1 ' •{-1 6 , f' alaicq 2. Property Information (example 1S234AB01400) 3. Owner Information ` Tax lot ID(s): Name: Grett eih / t FtA 11t /Ok PA in Company: }� t � , Address: 1311 iV✓ 1ZOGkt 4i w - A/. Site Address: iJ Iill SW POC.�%f}1jNAYYI VY1tlPr City, State,Zip:"Tj041 DR• ]Z7i City, State, Zip: - Ti a,-d 01 M Phone /Fax: J i Nearest Cross Steel? .51A/ I3 P -pc VFI 2 - E -Mall: 4. Development Activity (check all that apply) 6. Applicant Information l . �, Addition to Single Family Residence (rooms, deck, garage) Name: itect�.iAilt MOO/ A/10 to ❑ Lot Line Adjustment ❑ Minor Land Partition Company: t01\15'I'VUI+ dP4iv I..4 ❑ Residential Condominium ❑ Commercial Condominium Address: 3/20 .SVIi 13A j b ❑ Residential Subdivision ❑ Commercial Subdivision City, State, zip: Pav1'(and OF- Zl °{ ❑ Single Lot Commercial ❑ Multi Lot Commercial Other Phone /Fax. q73 5 1 (' ( -• E -Mail: i i'15 - t �OV Y - i 6. Will the project involve any off -site work? ❑ Yes 'allo ❑ Unknown Location and description of off-site work f i 7, Additional comments or information that may be needed to understand your project 010'4 fie VA./ Act Cs.cks )) ovt(lt,�'j-il\A bra boo- a hovsc ItiI 1r DIA t°,xi5 fig (a.hcA l This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ 1200 -C Permit or other permits as Issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate. Print/Type Nam Adrial l't Ci 6100AM/I V\ Print/Type Title DWKG'')(,O4,Siirt/C i(61dfV1 Signature d• ( Date 2- I 9 1 �I 1 J FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the site, THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. ❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site, This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02,1. All required permits and approvals must be obtained and completed under applicable local, State, and federal law. ❑ Based on review of the submitted materials and best available Information the above referenced project will not significantly impact the existing or potentially sensitive area(s) found near the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ Is Service Provider Letter is not valid unless CWS approved site plan(s) are attached. w h The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDE ETTER IS REQUIR D. . Reviewed by /= --- ' - S! ` _ ._ Date 9 '2550 SW Hillsboro Highway • Flillsboro Oregon 97 Phone (503) 081- 5100 , ( Fax 601- 443 www.cleanwaterservices.org