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Permit CITY OF TIGARD MASTER PERMIT �P ` ;,. COMMUNITY DEVELOPMENT Permit #: MST2011 00195 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011 TIGARD Parcel: 25101 BC00500 Jurisdiction: Tigard Site address: 12300 SW KNOLL DR Subdivision: KNOLL ACRES Lot: 10 Project: Stolt Project Description: Interior remodel to lower floor. Electrical and mechanical under separate permits. 11/16/2011: REPRINT permit to include furnace, gas piping and (1) additional water piping /DWV BUILDING Floor Areas Required Setbacks Required Stories: 0 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: 1 Third: 0 sf Right: 0 Detectors: Yes 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 0 Drains: Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Dra Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 2 Drywell- Trench Drain: 0 Other Fixture Units: Water piping /DWV - Kitchen & laundry roc MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 1 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 add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 0 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: STOLT, FRED 4M CONSTRUCTION Required Items and Reports (Conditions) 12300 SW KNOLL DR PO BOX 611 TIGARD, OR 97223 MARYLHURST, OR 97068 PHONE: PHONE: 503- 290 -8053 FAX: 503 - 557 -0377 Total Fees: $627.06 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 OAR 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 By: � Perm ittee Signature: /��^�aJ��/ t 1 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. 11 11 1 CITY OF TIGARD MASTER PERMIT ,'° COMMUNITY DEVELOPMENT Permit #: MST2011 -00195 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10!2011 Parcel: 25101 BC00500 Jurisdiction: Tigard Site address: 12300 SW KNOLL DR Subdivision: KNOLL ACRES Lot: 10 Project: Stolt Project Description: Interior remodel to lower floor. Electrical and mechanical under separate permits. BUILDING Floor Areas Required Setbacks Required Stories: 0 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: 1 Third: 0 sf Right: 0 Detectors Yes 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: 1 Drywell- Trench Drain' 0 Other Fixture Units. water piping /DVW 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: 0 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 addl 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 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: STOLT, FRED 4M CONSTRUCTION Required Items and Reports (Conditions) 12300 SW KNOLL DR PO BOX 611 TIGARD, OR 97223 MARYLHURST, OR 97068 PHONE: PHONE: 503 - 290 -8053 FAX: 503- 557 -0377 Total Fees: $481.37 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 r , - -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy o' e rules o •direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued = - Permittee Signature: /, '/ C. ::' 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. Plumbing Permit Application., Building Fixtures Foa OFFICE USE ONLY City of Tigard Received t / Date/By: J& l � I rmtt No.: 7 �/ � q 13125 SW Hall Blvd., Tigard,OR 97223N V 16 2011 y < j / C 0 2 .4 4/.. d . 0 1 9_5- 2 • Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: � (� T I G A R D Inspection Line: 503.639.4175 CITY i OF T1G t yt D Date ReadyBy Suns See Page 2 for Internet: www.tigard- or.gov FBI !I! nINICZ fy'1fiC4il`V Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description Qty. I Ea. I Total p Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 J t 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ 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: j 3 O St/ /L+Va (,1..- O it_ Catch basin or area drain 18.76 City /State /ZIP: ( 9 Drywell, leach line, or trench drain 18.76 L / 9 O� 7 2 a):3 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: I Project name: S'7L ( Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear It.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 /9-6 L DESCRIPTION OF WORK ‘ , p ell r 4' Backwater valve 12.51 pp / Clothes washer 25.02 I 'I / � 57no A-, (YJ 1-4✓VJOft /0C-✓ /3" 77) Dishwasher 25.02 Rgid i e 7 7$/ ? Caa fi.e Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 I. APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 /` Medical gas (value: $ ) Page 2 Business name: `7m CU,(4S7 ) iNJ Contact name: Primer 12.51 QUST/ 2 0 138 /r.fS Roof drain (commercial) 12.51 Address: Pa 66>c 6`( Sink/basin/lavatory 25.02 City /State /ZIP: nw, r y`} - r 6 - j (. Solar units (potable water) 62.54 Phone: ( y) a°i6 _ 5 3 Fax: : ( ) Tub /shower /shower pan 12.51 E-mail: �v) j)rr A t/vtnC 7- /Z,vc7) d,4 • Coo" - Urinal 25.02 CONTRACTOR Water closet 25.02 �/,� Water heater 37.52 Business name: Ad& 1 ii- vll'ilnic Water piping/DWV / 56.29 Address: I ys0 `f SvJ F Other: 25.02 City /State /ZIP: 77 yiyf._ (pt. 9 a Subtotal ,Phone: (5b3) j- 7c' _ 3 Fax: ( ) Minimum permit fee: $72.50 .6\4, Lie.: / . y7 9 , V /// /l Plumbing Lic. no.: P f, 3y X - / / // Plan review (25% of permit fee) / State surcharge (12% of permit fee) Authorized signature: ___&.,,___&.,,,,..( _ ___& e 7 TOTAL PERMIT FEE Sf Print name: �t- Date: 1 �(0 %,L This permit application expires if a permit is not obtained within 180 days �t/P v1� - �7c i1 after it has been accepted as complete. *Fee methodology set by Tri County Building Industry Service Board. I\ Building \Permits\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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to 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 ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower - Jacuzzi /Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain /sink: - 2" 3" Isometric or Riser Diagram 4 " ❑ Isometric or riser diagram is required for new buildings - Car Wash Drain Garbage Domestic non -food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach./Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: - Lav/Bar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Buil ding \Permits\PLMF - PermitApp.doc 08/04/2011 2 Plumbing Permit Application Building Fixtures {, .- --_ -__ _ - -_ - - FOR OFFICE USE I City of Tigard Received // n / ✓ / Permit No.: �GJra�!„�19� q 13125 SW Hall Blvd., Tigard, OR 9722 DDate/By: 7 � ` ® Plan Review Phone: 503.718.2439 Fax: 503.598.1960 a "01� Date/By: Other Permit No.: Inspection Line: 503.639.4175 ` 1 0 Date Read B Juris: ® See Pa e 2 for TIGARD Qv Y Y g Internet: www.tigard- or.gov _ r , ��)N Supplemental Information TYPE OF WORK ..° \i ° ‘ n2i9 OP" FEE* SCHEDULE ❑ New construction ❑ Demoliti�n+ ^�,t" v For special information use checklist � °° Description I Qty. I Ea. I Total W Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 14 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ 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: / a3 00 S v.1 /°-,o C.0 OA. Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: 640.4 d ( 9 ?° 3 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: I Project name: S m C f Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 /'I 4 (L 717 14-0 C- L D /L Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: _ ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 (937 ? [� lC/s 77,,f , PL I/:-ht3 /• 1 ✓L ( - 41f..4)/t) / Dishwasher 25.02 S- vi'i°L ( Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 U Medical gas (value: $ ) Page 2 Business name: / / Cord S oC7 1--- Primer 12.51 Contact name: ,OvST7„) AUa( ( Roof drain (commercial) 12.51 Address: PD Joe G (( Sink/basin/lavatory 25.02 City /State /ZIP: 4462 ( A / ✓nST 97 3 & Solar units (potable water) 62.54 Phone: (s ) .- o _ 86 j- 3 Fax: : (Sb3 ) cS 7 ,- v3 , Tub /shower /shower pan 12.51 E -mail: ,� Urinal 25.02 o57 �' �//t� Co�ls%7wc77o� � Con. Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: P P LJr t&rsiG Water i to DWV i 56.29 ` .--- 4 0 Address: I /_ ro S s l tf, Other: 25.02 City /State /ZIP: 6,2 r/ G/ 6K 7 d co- Subtotal Phone: (5 7 3 3 ' Z b Fax: ( ) '74 A Minimum permit fee: $72.50 "7),, Plan review (25% of permit fee) CCB Lic.: 10.-.( Yl 3 -c3-0 Plumbing Lic. no.: p� / I State surcharge (12% of permit fee) E -70 Authorized signa 4,(7 TOTAL PERMIT FEE g - i , Print name: / ^ � 4 e, I This permit application expires if a permit is not obtained within 180 days LA.) . ° 1 _ Date: i (� - �, after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. P'Building\Permits\PLMU- PermitApp doe 10/01/09 440- 4616T(I0 /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 - I st 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 l� 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 * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: -Tub /Shower engineer. - Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain /sink: - 2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non -food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach. /Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay /Bar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet- Toilet plumbing permit can be issued. Urinal Other Fixtures: I: \Buil ding \Permits \PLMF - PermitApp.doc 08/04/2011 2 Mechanical Permit Applicatio 1V .FOR OFF USE ONLY City of Tigard . a r _ - . Daceiv / s FV r �)i•,� �� - PermitNo.: 4 III n 13125 SW Hall Blvd., Tigard,OR 97223 y Date � 7/ � �/ I : Phone: 503.718.2439 Fax: 503.598.1960 NOV 1 6 2 011 Plan Review Date/By: Other Permit: T I G A R D Inspection Line: 503.639 Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard- or.gov CITY OF TIGA D Notified/Method: Supplemental Information BIM! O NG D ViSiC \t TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction E Addition /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* J 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: ) s ) 3 O g J J [J/t. (requires site plan showing placement) 46.75 City /State /ZIP: I Furnace 100,000 BTU (ducts /vents) / 46.75 774:, J ayL 97 3 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: 3'ra.1.4— 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 Gas fireplace 33.39 C O.^r"/Z` i3/p. 1 0 f , ct- Flue vent for water heater or gas 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 Fax: Single -duct exhaust (bathrooms, Phone: ( ) ( ) toilet compartments, utility rooms) 23.32 J APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Ca`rr l rz _J Fuel piping: Contact name: LXJy7..i Rclt;6/r4S $14.15 for first four; $4.03 for each additional Furnace, etc. Address: PO 46 6 Gt Gas heat pump City /State /ZIP: /444x y(/./ ,r cwt._ 97C13 , Wall /suspended/unit heater Phone: ( ) Fax: ( ) Water heater S�3 �S - S 3 Fireplace E - mail: 4, 477,4 A Yrut co si7L✓i 77c.1. ca,,,,_ Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 9, i 56 Plan review (25% of permit fee) CCB lie.: State surcharge (12% of permit fee) /O I a TOTAL PERMIT FEE /©D , F() Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ` - _ A?" ` Date: /HIV/ l/ * Fee methodology set by Tri- County Building Industry Service Board I. \ Building\ Permits \ MEC - P /r itA 09/09/10 440 -4617T (11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including . $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. L\ Building \Permits\MEC- PermitApp.doc 09/09/10 2 Building Permit Application Residential FOR OFFICE USE ONLY • City of Tigard i � Date/B l/� T erri Permit No.: 7 ° 13125 SW Hall Blvd., Tigard, OR 2 Plan Revie il� - NI a _ . �� Other Permit: M�� ��l 7 Phone: 50 3 . 7 18 . 2439 Fax �`.. 8.1�9 Date/B : �1,♦ _ TI G A R D Inspection Line: 503.639.447 % \\ Date Ready By: Juris ® See Page 2 for Internet: www.tigard -or.go 03 Notified/Method: Supplemental Information • TYPE O WORK T' r 6.)" REQUIRED DATA:.1- AND 2- FAMILY DWELLING '1. �`T \P 0 Cti ❑ New construction r " �f lit to io n Permit fees* are based on the value of the work performed. erformed. De 1 0 �. Indicate the value (rounded to the nearest dollar) of all {� 6 ' ° , Addition/alteration/replacement 'Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. (A 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ O t OU\. ❑ 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: I 2, 3 0 0 5 - lLnr� c. L /OL New dwelling area: square feet City /State /ZIP: 77 G•�M - 0( 5 ) a7-3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: S`7-6 LT Covered porch area: square feet Cross street/directions to job site: Deck area: square feet l 74 - t-1- 7b /(,p trL .O/L Other structure area: square feet REQUIRED DATA: COMMERCIAL -.USE CHECKLIST ' Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK . work indicated on this application. Valuation: $ A *rte - , � +r te `Fe , I DI-a- C ''7uarL .ao0i2S V-(0-- �1/�n7< , Existing building area square feet SLZ er e et .$ g/ ,, Paite t r--- New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name:, Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: rp APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* • Business name: 041 �`S�•�.Z�� (Please refer to fee sclredule) Structural plan review fee (or deposit): Contact name: dU r p. /Zo'(,Q WS Address: FLS plan review fee (if applicable): Pa �, X 1( Total fees due upon application: City /State /ZIP: !14/5(tyCA 57 O) T Phone: (5 ) al o -y--6)- Fax:: (5 ) 5-5-2 _ 3 7 7 Amount received: 5 Y E -mail: 4 (' Y ��f7 vc7 ° �jy� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top 'counted PhotoVoltaic Solar Panel Syst-m. Business name: 11 Cf..)1 I `J- _ G *C Submit two ) sets of roof plan with conne -'on details V I r -t t^ and fire dep. ' ent access, along with 2010 Oregon Address: Solar Installation .ecialty Code --cklist. City /State /ZIP: Permit Fee (in des p • - review $180.00 and admi ie.i alive fees): Phone. ( ) Fax: ( ) State surchar: - % of pe ee): $21.60 CCB lie.: ( $ ei L� 1�s //3 7 Total fee due upon application: $201.60 Authorized signature: % A, %;161) This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: asn,..) / 09 / „r5- Date: IF y_ // I * Fee methodology set by Tri- County Building Industry J Service Board. I:\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY 11111 City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/13y: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ' t Yes 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- El ❑ ❑ 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 ❑ El ❑ 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 ❑ El ❑ 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 al •licable to the .ro'ect under review. JURISDICTIONAL 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- RESPermitApp.doc 02/24/2011 440 4613T(11/02 /COM/WEB)