Permit . X CITY OF TIGARD MASTER PERMIT
ii
` COMMUNITY DEVELOPMENT Permit #: MST2011 00208
,- u 13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2012
CIR I� Parcel: 2S108AB05400
Jurisdiction: Tigard
Site address: 14217 SW 155TH TER
Subdivision: BRENTWOOD ESTATES Lot: 16
Project: Brentwood Estates, Lot 16
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 3780 sf Basement 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 4 Second: 1126 sf Garage: 750 sf Front: 20 Smoke
Dwelling Units: 2 Third. 0 sf Right: 5
Detectors: Yes
Total: 4906 sf Value: $538,981.40 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 7 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 6
F u rn> =100 K: 1
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'l 500 sf: 10 201 -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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 4906
Owner: Contractor:
STEEL CREEK HOMES LLC STEEL CREEK HOMES LLC Required Items and Reports (Conditions)
7327 SW BARNES RD #507 7327 SW BARNES RD #507 1 Ersn Cntrl 503 - 681 - 4444
PORTLAND, OR 97225 PORTLAND, OR 97225
PHONE: 503 -519 -6078 PHONE: 503 - 519 -6078
FAX: 503 - 987 -1448
Total Fees: $24,065.29
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 .. - • dance 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. •TTENTION: • -•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. ose rules are set rth in OAr
952 -J01 -0010 through OAR • • -.. 00•: You may obtain a copy of the rules or direct questions to OUNC by calling 50 .232.1987 or 1. t10. .2344.
/.t,
Iss d By: / /� Permittee Signature: • VAMMELA
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.
I
Building Permit Application
Fi FOR OFFI USE ONLY
City of Tigard 50
Date/B 1l L�7 Permit No.:
,� 1i u ,, 1 `
1, . 13125 SW Hall Blvd., Tigard,OR 9711 f 1 Plan Revie /
9 ' Phone: 503.718.2439 Fax: 503.598. `.i' 1� 1 • Date/B : ` *qv Other Permit:. / 4 l ,1-d-� 5
TI G A R D Inspection Line: 503.639.4175 �� Date Rea. y : y: ® See Page 2 for
Internet: www.tigard- or.gov O S`r pf Notified/Method: M`' Supplemental Information
• TYPE OF WO G` Q`� - ® `S`O • z REQUIRED DATA: 1- AND 2- FAMILY DWELLING
ew 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.
1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ cJ �� • j
El Accessory building ❑ Multi- family Number of bedrooms: \ 2 j
Ar
❑ Master builder ❑ Other: Number of bathroon
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 2 (.� ?� 7 1 Ira c---c New dwelling area: ..9p(�) square feet
City /State /ZIP: °/ It _ y '77 72j.j Garage /carport area: 7 square feet
r �` u
Suite/bldg. /apt. no.: Project name: Covered porch area 500 square feet % 1
Cross street/directions to job site Deck area: square feet ' 3 75$
S lit./ V J (I /✓I QI.ov i i . Wc4 Other structure area: 5( square feet a �
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: v. t,,\_ /.✓00 J I 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.
AL le.) COIAS I ° ✓ ate Valuation: $
Existing building area square feet
New building area: square feet
KPROPERT OWNER I ❑ TENANT Number of stories:
Name: S..�,�{ I re .t.e k /4rll•�E." I �I '� / Type of construction:
Address: �^ Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax:( ) New:
X APPLICANT ❑ CONTACT PERSON NOTICE
Business name: A444 4.t ( 6. � { \ (-601---1 4-s ��� All contractors and subcontractors are required to be
• j licensed with the Oregon Construction Contractors Board
Contact name: l v - , `r ,,
under ORS 701 and may be required to be licensed in the
Address: °13 _ J (( r'i .,s so7 jurisdiction in which work is being performed. If the
City /State /ZIP: ✓ . 012. /.�7� �7" applicant is exempt from licensing, the following reasons
_1 fib+ apply:
Phone: (5v3) 0o Fax::( 3) .3.5 . - S5 - 6 6
E -mail: AI/ICJ 0. t-t I Gr� .c i 4L, � Ls . Kt " fl -
CONTRA TOR BUILDING PERMIT FEES*
Business name: �•-.t- (,•. / (" .. 1
(Please refer to fee schedule
1 /.../.01,./ , / Permit fee:
Address: "3� r-1.x/. t iYY(S !`mil 5f 7
City /State /ZIP: /1 rtm �� q 7 State surcharge (12% of permit fee):
(/" i FLS plan review (40% ofpermit fee):
Phone: (513 ) '-'( 9 -GA-7T Fax: (50) ,t r-7,__ l sj (Due upon application.)
CCB lic.: ! '5 Z q 6 7, _ _ Total permit fees:
Authorized signature: / ///
Amount received:
_ `� ` ` This permit application expires if a permit is not obtained
Print name: ft ' i ' Date: 2 _ �� (/
* within 180 days after it has been accepted as complete.
®� t Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\FPS- PermitApp.doc 02/01/2011 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial. Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45 •
3,601 to 7,200 $310.05
7,201 and greater $404.39 •
Sprinkler Project Square Footage: sq. ft. •
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\ Building \Permits \FPS- PermitApp.doc 02/01/2011 2
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received
Date /By: �� ,�� Permit No.: *_ _ ��. C
13125 SW Hall Blvd., Tigard, OR 97223 +. Plan Review
0 Phone: 503.718.2439 Fax: 503.598 . , ' Date /By: Other Permit:
-T tGA R D Inspection Line: 503.639 A Date Ready /By: ® See Page 2 for
Internet: www.tigard -or.g \\ Notified/Method: Supplemental Information
T ^ 7 'rn0�
TYPE OkIWORK \C1 i.,,:' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
ie Mechanical permit fees* are based on the value of the work
New construction ❑ Addition/a161.0 g tt ent performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: ` mechanical materials, equipment, labor, overhead, and profit.
2 1\\\.1C 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. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: ) iiAl 7 v . " J f y / ,` v- „( (requires site plan showing placement) 1 46.75
City /State /ZIP: i (/ �,, t /� Furnace 100,000 BTU (ducts /vents) 46.75
l O ` 7 zAii Furnace 100,000+ BTU (ducts /vents) ( 54.91
Suite/bldg. /apt. no.: Project name: o j'' Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
5 „ ) � I I �'_/� r ,Q p_ Hydronic hot water system 23.32
(�V �`O✓tt t PQ-4-1- Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
/^ Flue /vent for any of above 23.32
Subdivision: l &
Lot no.: /
Other: 23.32
• Tax map /parcel no.: Other fuel appliances:
D SCRIPTION OF WORK Water heater 23.32
p� � �� Gas fireplace 2 33.39 106 0d �a9h5 I o ti 1 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
PROPER Y OWNER ( ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: S-[..e,4_ 6.,i (-(0 „ t d,k_c__ Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment I 33.39
City /State /ZIP: Clothes dryer exhaust I 33.39
Single -duct exhaust (bathrooms, �'/
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 1 23.32 7t--
1g APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans • 23.32
�� �1 f .t { 1 /- , ! Other: 23.32
Business name: ( � j ' �„I S 1-.1^C--- 170Lvt t Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: 73 X7 vi xt cs . 5-07- Furnace, etc. ) 14; 1"
Gas heat pump
City/State /ZIP: i i , i ����p , I (/W_ ' 7 Wall /suspended/unit heater
Phone: (5T/3) 6"/G! .,( 4 S Fax:: (3-03) 35-2....5-5-626, Water heater 1
t 0 k L 4 Fireplace Z
E -mail: 1 �GG L/'dl -C �S K� Range 1
CONTRACTOR Barbecue I
Business name: T J co 1 0 r/ ; ! L Clothes dryer (gas)
Other:
Address: , $ .r 4 1 1 wtt 1, r Ai f,,L MECHANICAL,PERMIT FEES*
City /State /ZIP: Pov j! I ow q 770 Z Subtotal 44 , er
� 3 {.i _ "l (S03) _ Minimum permit fee ($90.00)
Phone: (GO) 7? ? � Fax: L 3 7 Plan review (25% of permit fee)
CCB lie.: J L//•� I _ State surcharge (12% of permit fee) 3 ,
/ --- TOTAL PERMIT FEE 7, 'Z'?
Authorized signature: � AaIIIIIIIIIIP This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: l r 4 Date: -/ S'_ * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building V'ermits \MEC -PermitApp.doc 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.
I:\ Building \Permits \MEC- PermitApp.doc 09/09/10 2
Jan 1 0 2012 2:28PM HP LRSERJET FAX 50335805 1 3 p . 1
, .•
Electrical Permit Application ?Rx c;i,„\\1
_ •
City of Tigard re(0„. R
Permit No.: 096 .fre 6
„-- . 13125 SW Hall Blvd, ' Tigard, OR 97223 1 la
' yt
_en Review ...
7 1 • "'' Phonc; 503.718.2439 Fax: 503.598.1960 k
..t.tniN6‘41)atetEsy: Other Pennit:
TI G P D
Inspection Line: 503.639,4175 . ., 1 r ic. ‘‘ ., Reedy/By. Jude gi See Pep 2 f o
A . r
Internet; www.tigard-or, gov CA \ I `-' n\N ‘4 Supplementai Info rm salon
.ftritifit;; ;; .r.' ■ ' ;mo. •-,;,:',.'..•.;..,:' 4::.ia:.1.4t4t4Mttptti
Please cheek all that apply (submit i sets apiaries whlenag checked below):
C New construction C Addition/alteration/replacement
['Service or feeder 400 amps or more M Building over three store.
1: Demolition 1=I Other: where the available fault currant M Marinas and boatyards.
. .
!,:;:q1,4f,•;:i4g;%:::::::-.4N':1,5.:f.:Wi.7.0;.0.:' t oittiW,OtiStSjr*Ictlail:; ; :::Pi4.4i;::.:' , '. ' :.'., . „,, ,,:,: ey,4eeds 10,000 amps at 150 volts or C Floating buildings,
less to ground, or oximede 14,000 I: Commercial-use agrieultural
E 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
C Multi-family 1:1 Master builder El Other: 1:11Firo pump, 0 Installation of n KVA or
larger aeparetely derived system,
ii;1; ;;E : EF44.PliN7440,%rttli*Rifitr011:AINOWOOPOW,;T::: l' . Ci Addition of new motor load of CI
100HP or more, occupancy.
Job DD. : Job site address; i ( 2_1 7 6to '5 5 / c Six or more residential unite, E:I Recreational vehisle parka.
City/State/ZIP: 0 Health-care facilities. M Supply voltage for more than
El lituardoue looations. 600 volts nominal.
Suite/bldg/apt. no.: Project name: CI Servios or feeder 600 amps or more.
0.810a4 yztfkiii0tOtIttlWe'lt::
Cross street/directions to job site: Delorlotien I 0tY, I Fee. I Tow I •
Nev residential single- Or multi-family dwelling unit.
cludes attached garage.
Subdivision: - &i?-11-5 17;70. k L In ao° ,,, ft, or lose 162,54 4
Ea. adoll 500 sq. ft. or portion 33.92 i
Tax map/parcel no.; Limited energy residential
• - 75.00 2
iabliiiiigsiy .' ';;..Hi''..'' ,: , :::',' ,:!..,.: : .: .,,.., with above s.,11.
.._ .rsActis.iajvith.....tblasuiftL__,..._._._4,............ LImite• energy, mu W. amily 75.00 2
Services or feeders installationotteratIon, and/or relocation
200 amps or less 100.70 2
,„,::.
,,,, •"sT• 7,-.-.1 ::...k,.1::: , ,,"■;•:,'•..i,i41.0..:. - - - e.:.••;43X'a,.,, : : 201 amps to 400 amps 133.56 2
:y.„.„1...,.!,:„:,., ..14,',1,1:7:-,, ,. , - - --
401 amps to 600 amps 200.34 2
Name: -
601 amps to 1,000 amps 301.04 2
Address; Over 1,000 amps or volts 552.26 2
---, _
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
_ - .. .,
_
Phone: ( ) I Fax; ( ) 200 amps or less 59.36 I
• 201 amps 10 400 amps 125.08 2
Owner installation: This Installation is being made on property that I own which is not
intended for sal; lease, rent, or exchange, according to CRS 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
- : ...Mtar-ii**ast'A . .," j q0..: .. or s,.:,...„ .: . ab°Y° SerVIC° °r fred15r f "' 7,42 2
each branch circuit
Business name; B. Fee for branch circuits without
— service or feeder fee, first
18 2 6.
Contact name: branch circuit 5 —
Each add'i branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP; dwcilinn. service and/or feeder (57.84 2
Reconnect only 67,84 2
Phone: ( ) Fax: : ( )
Pump or irrigation circle 67.84 2
B-mail:
Sign or outline lighting 67.84 2
7.rettO: % :.':::..':, :•''';':••.'.‘ ;': Signal circuit(s) or limited-energy
Business name: RK Electric, Inc. panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in env of the above
Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.25/ hr
- ., . .
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Hillsboro, OR 97124
. Industrial. plant (I hr min) 78.18/ hr
Phone: (503) 640-1344 Fax: (503) 356-0 513 Inspections for which no fee is
90.0W hr
.
— specIfIcally ('/ hr min)
CCB Lic.: 94275 Electrical Lie.' 34-375C Suprv. Lie.: 4724- idlta.BICAri..40,1e,fitii6 S
_
Subtotal;
- -
Suprv. Electrician signature, required: eiF • •
Plan review (25% of perrnit flee):
Print name: Ron L, Kurtz Date: State surcharge (12% of permit fen);
. , .
TOTAL PERMIT FEE;
Authorized signature; (O i{
.
This permit ipplication expires if a permit Is not obtained within 180
days after It has been accepted as complste
Print name: Ron L. Kurtz Date: , t Number of inspeotions allowed per perinit,
lAnuilaisopernsiounte-rernatApo.doo 07/01/l0 440 1/05/C 0 [WM
Plumbing Permit Application
Building Fixtures `` FOR OFFICE USE ONLY
City of Tigard Received Permit No.: ` �y/
1111 \ !• -it: /,‘ \� Date/By: 01�� _ ga f)
. - 13125 SW Hall Blvd., Tigard, �� 2 ``,, Plan Review l iJ
Phone: 503.718.2439 Fax: 51`, . '' 1' 19tt 1 Date/By: Other Permit No.:
O
TIGARD Inspection Line: 503.639.4175 � ` �• '
'` \G Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard - or.gov -cioc. R ` �� � Notified/Method: Supplemental Information
KG \\\a v\
TYPE OF WOR� FEE* SCHEDULE
New construction ❑ I %iition For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I , I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath r 500.32 � z-
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen + 25.02 0,. j, D`L
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND 'LOCATION Site utilities:
Job site address: J 1 7 51.) /.5 - ray C ( Catch basin or area drain 18.76
Drywe
City /State /ZIP: << � O� �-faz/ ' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: V I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
,6 ■1 6 ( ] 6 d / 1 P e'tfrv`itt t VZ.--u p 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: V_ t 0 cJ I Lot no.: 1 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
D CRIPTION OF WORK Backwater valve 12.51
60±7/ � Clothes washer 25.02
L4 v a`d°'� Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
pf PROPERTY OWNER ' / I ❑ TENANT Expansion tank 12.51
Name: ��„(„C (.6'_
( _ (< -n ,Ls lint- - Fixture /sewer cap 25.02
�� dd�Y/ , 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
p• APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 '
Business name: C �
� ( / { if� o� S Medical gas (value: $ ) Page 2
{� ,_ , Primer 12.51
Contact name: l 0a v l
ff Roof drain (commercial) 12.51
Address: 73 Z 7 . ,) Gl1/ti S Ij ' 5�-7 Sink/basin/lavatory 25.02
City /State /ZIP: � i,"-ri ore q7 --5-- Solar units (potable water) 62.54
Phone: (503) g '(a ---( is ` Fax:: (JOS 3S,Z , 5t-we Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
�co/l 0 5 / d ' -t { kinp�ln is , k't. Water closet 25.02
CONTRACTOR
f _ Water heater 37.52
Business name: OiL P" J� (; _ -. Water piping/DWV 56.29
Address: P f � , )x 9� - _ ¢ Other: 25.02
City /State /ZIP: S74 P4, / ( aie 1) I07 Subtotal j, -
Phone: ( 'ca) 5-6,_,_ „ '�,v )..6 `s� ^ Fax: ( �j 3 ) (2? 7,,,_ g?-76P Minimum permit fee: $72.50
CCB Lic.: I V11372.., ts Plumbing Lic. no.: po �t Plan review (25% of permit fee)
!l State surcharge (12% of permit fee) jo5 ,04-
.. I
Authorized signature: TOTAL PERMIT FEE jg e„..---2
Print name: 34.4_,,,,'; t This permit application expires if a permit is not obtained within 180 days
(' Cl Da fir)/ ��_ after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
• I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(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 - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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 ❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: -rub /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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF - PermitApp.doc 08/04/2011 2
Ig • 7 ( i(
� . I A
Building Division /,ST
Development Code Provision Review
T[GARD Residential Projects
Building Permit No: 1 (a r \ST&. t I — Vv c) 6
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A t�Y
Routed Plans:
Original Plan Submittal Date: ( 0'
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 (✓) 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. -a,
Planning Review (contact f_ ,� •
at 503 - 7�18 - T(S�Sr l� 14 �'l = @tigard- or.gov)
Land Use Case No. 09'OOOO Na me / iLwl,4
Haig
EV Setbacks: `
Front I Rear /5 Side J Street Side / Garage
(/Maximum Building Height .75 Actual Building Height
GYVisual Clearance
(Easements f
❑ Sensitive Lands Type:
Notes:1C 124,4- t�,�va.�, 2,0 S 7 e.
Flg f L® + par t ` � ,04v► 14 GA_
Original Plan: Approved Not Approved ❑ Date: l it 411
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)
K- Actual Slope:
Notes:
Original Plan: Approved Not Approved ❑ Date: / Z 2.-
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)
®%Street Trees
O Protected Trees
Notes: /16 af S'08 ,,.
Original Plan: Approved D Not Approved ❑ Date: h, / /!j
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 Applicant
Okay to Issue Permit: Yes, No ❑.. •
Date Routed to Building: /
Page 2 of 2
R E c ElvED r
DEC 202011 = _.
� ' ..6 EASEMENT dl
CITY OF TIGARD ^___. -_ �._ . _w__ _ ___� -- :"
r
BUILDING DIVISIO �� _� - -. ✓= . �';
aasm .i -\ f
Ns,,IL \ . x40 . -. s.- _
i .. ::1 i
N . \ :,: , ,
., ,
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'-,,,.' -- flk ___ ,40.01:-.0<, .-', 11 :.: V!
-(e/ N 0 .. .. _ : _._ _ _. _ „AI
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N ■ . I; .:"...... ; . . ..: 2.. I .. 1,! .: ..:' ' . ..-: .': • A - - .
,; 40
PLOT PLAN SCALE. • 20'
LOT 16
BRENTWOOD ESTATES
TIGARD, OREGON
4 RESIDENCE Foil: TOM 4 MELINDA JAG A
CITY OF TIGARD RECEIPT
11 1 1. it al .. 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 184902 - 12/15/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2011 -00208 Plan Review 230- 0000 -43106 $750.00
Total: $750.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card BTAGGART 12/15/2011 $750.00
Payor: D-aj ct tk.*U 7S' -
Total Payments: $750.00
Balance Due: $1.34
Page 1 of 1
•
Oregon Residential Specialty Code 8318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
1 , am the general contractor or the owner- builder
at the following address:
Site Address: 575-`111
City: -�
/ irA-frcj
Permit #: N5777011 -c d5?
Subdivision/Lot #: v��ti� O�PI 4/-/
�
and/or
Map and Tax Lot #: /2,s oq 416c25,406
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918 - 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture- sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
4/
Signature: Date: /4/z_
G = neral Contractor or Owner- : uilder
• IABuilding\ Form \RES- MoistureSensitiveWood.doc 09/25/08
•
•
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: 11 Tal , _ no Jurisdiction: Y ,J
Site Address: L f S T S
Subdivision/Lot #:
and/or
Map and Tax Lot #: ( A 60_0-4 ad
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: Date: Vg /( Z
• caner /General Contractor /Authorized Agent
Print Name: t ( c..-- , 41.AJ
ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\Building\Forms\RES- HighEfficiencyLighting.doc 07/01/08
STREET TTREE
TIGARD CERTIFICATION
5 owner /agent for��t.e.t 4-4.4_ -r /41 14 3
(PLEASE PRINT ) (PERMIT HOLDER)
do hereby certify that the following location meets .
City of Tigard land use and development standards
for street tree installation and is consistent
with the approved site plan.
PERMIT NO.: /I f -677o I / -0O20
SI1 E ADDRESS: 7 / S . .
SUBDIVISION: r gej LOT #: /6
SIGNATURE: l`� _ _ - _ DA"1 E:
' AGENT)
RECEIVED &
VERIFIED BY: _ DA1 E: 3
OF TIGARD)
❑ Tree location verified per -.proved site plan.
I: \Building \Forms \StreetTreeCertificate 05/30/2012