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Permit q CITY OF TIGARD MASTER PERMIT I : COMMUNITY DEVELOPMENT Permit #: MST2012 -00021 T [GA R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2012 Parcel: 2S110BC07800 Jurisdiction: Tigard Site address: 12426 SW ASPEN RIDGE DR Subdivision: THORNWOOD Lot: 49 Project: Thomas Project Description: Add bathroom in basement. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 80 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 80 sf Value: $8,900.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckfiw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: . 1 Fum <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 add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 1 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: ADD SF VB R -3 80 Owner: Contractor: THOMAS, JON M & JACQUELINE P WESTCOAST HOME IMPROVEMENTS Required Items and Reports (Conditions) 12426 SW ASPEN RIDGE DR 59045 W TAYLORS FERRY RD. TIGARD, OR 97224 PORTLAND, OR 97219 PHONE: PHONE: 503 -550 -1679 FAX: 503 - 246 -4058 Total Fees: $621.16 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code- and . I 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 issua , or ' work is suspended for more the 180 days. ATTE •regon I. requires you to follow the rules adopted by the Oregon Utility Notification •- nter./ Those rules are set forth in OAR 952- 001 -0• 0 through O • - • _ -00 %i0. You may obtain a copy of the rules or direct questions to OUNC by calling 50 I .1987 •r .800.332.2344. Issued B : _ Permittee Signature: iAl 4 4 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. $uilding Permit Appli s EgIVED Residential FEB 2 2+ 2012 FOR OFFICE USE ONLY R r i 1 • City of Tigard n�� Date /B eceived a �, Permit No.: i , c — „ 40 0111- 13125 SW Hall Blvd., Tigard, T1Gt. Plan Review •,� C Phone: 503.718.2439 Fax N L � j p Other Permit: ��� Div�s�o Date /B � © - t G A R l � Inspection Line: 503.639.41 111��3 Date Ready /B : , /arts: HI See Page 2 for Internet: www.tigard or.gov Notified /Method: S S 9.. Supplemental Information IS L.V,rn. Vd1Leer TYPE OF WORK REQUIRED DATA: I- 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 F Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. V and 2- family dwelling ❑ Commercial /industrial Valuation: $ 89420 Number of bedrooms: ❑ Accessory building ❑ Multi- family r ❑ Master builder El Other: Number of bathrooms: ` JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 124.16 •,t 1, ""�� �� f Qi , ` New dwelling area: ' square feet City/State /ZIP: N`Ll►C �� Garage/carport area: square feet Su /apt. no.: I Project name: g(, ,,, texs Covered porch area: square feet Cross street/directions to job site: �� Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 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 i1 i ESCRIPTIONOF WORK work indicated on this application. "4'45 5a �,� Valuation: $ Existing building area: square feet New building area: square feet D _PROPERTY OWNER I ❑TENANT Number of stories: Q ... Name: \ 'l M u S Type of construction: 1 Address: q ({26 S 60 ,1 Me e 84, Occupancy groups: ...1 City/State /ZIP: i- fek fJ q � w Existing: ( 1 Phone: 6-417 Fax: ( ) New: I/3 jrAPPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* I Business name: i�i t�� �� Q � j �` (Please refer to fee deposit): J 2G�'��l! [v�•��r Q I-- Structural plan review fee (or deposit): M Contact name: * ©� C FLS plan review fee (if applicable): 1.2 Address: J co _� ty PeT / _ D 2,412.)::fricIpt Total fees due upon application: ' cce Phone: Ci /State /ZIP: F' r (f(� ( Z-Z1, ( l Q I Fax: ( ) Amount received: /// , �7`l V 10 l E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. Permit Fee (includes plan review City /State /ZIP: $180.00 and administrative fees): Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB tic.: 1,74 ®i Total fee due upon application: $201.60 Authorized si - ANIF • - This permit application expires if a permit is not obtained / , within 180 days after it has been accepted as complete. Print name: i � I Date: 2_22-- / Z * Fee methodology set by Tri- County Building Industry r�d�l. t,� Service Board. 1:\ Building \Permits \BUP- RESPennitApp.doc 02/24/2011 440 - 4613T(I 1 /02 /COM /WEB C 1(— _CO 3 — S 50 - 7679 VOL/e-&-R_ ' aiE i "-- / ,, ,, Y Building Permit Application Checklist ' - ' One- and Two- Family Dwelling. FOR OFFICE USE ONI.-Y ' of TI and Received g Date /By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 L I `, A R D 24- Hour Inspection Line: 503.639.4175 " ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov - . - - - • - ❑ Other: - '_•: , - THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar 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'completetl•lf . , ' copyright violations exist. . . 11 Site /plot plan drawn to scale. The plan must show lot and building 'setback dimensions;'prbperty 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 ''• ' y` r ' / 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 -, . .' . •❑ ❑ z ❑ prescriptive path analysis provide specifications and calculations to engineeringrstandards. , • • '. ' ' 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., , , , ■ ''s T . . 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: . , i , - •.' - , • 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof.truss)•shall be,stamped by, an engineer or , ❑ ❑ • ❑ architect licensed in Ore•on and shall be shown to be a I I licable to the ,ro u review. JURISDICTIONAL SPECIFICS , 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x II" 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. . 1:\ Building \Pennits \BUP- RESPermitApp.doc 02/24/2011 . 440 - 4613T(11 /02 /COM /WEB) -- - Electrical Permit ApplicationRE E VED FOR OFFICE USE ONLY City of Tigard Datee/Bea v" / IMP, / Permit,No.: , - r ° 13125 SW Hall Blvd., Tigard, OR 9722f EB 2 2 2012 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 • Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: furls: . el See Page 2 for Internet: www.tigard-or.gov BUILDING Drul$ION Notified/Mgihod: Supplemental Information TYPE OF WORK , PLAN REVIEW ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. - ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. ' CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 volts or, ❑ Floating buildings. . . less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other' - ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. . larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: 12426 sw Aspen ridge dr 100HP or more. occupancy.: , . ❑ Six or more residential units. ' ❑ Recreational'vehicle parks. City/State /ZIP: tigard, Or 97224 0 Health -care facilities. . ❑ Supply voltage for more than ❑ Hazardous locations. , 600 volts nominal. • - Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.` • FEE SCHEDULE Cross street/directions to job site: Description I DV,-. I . Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. . Subdivision: Lot no.: 1,000 sq. ft., or less . 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 " 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 residential (with above sq. ft.) _ Services or feeders installation, alteration, and/or relocation , Wiring of new bath room 200 amps or less 100.70 2 PROPERTY OWNER ❑ TENANT 201 amps to 400, amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 1— 601 amps to 1,000 amps 301.04 2 Addres Gi S • '� � Over 1,000 snips or volts 552.26 2 Ci /State /ZIP a I, Temporary services or feeders installation, alteration, and /or ty a� r elocation Phone: (93) 064 8 Fax: ( ) 200 amps or less , 59.36 1 201 amps to 400 amps 425.08 - • • 2 ' Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps • 168.54 2 ,.r intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. ,_ Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with , ® APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: Chanco inc DBA Chandler electric Fee for branch circuits without J erviee or feeder fee, first 56.18 ,1C� 2 Contact name: Mike Chandler Ea( branch circuit Each add'I branch circuit 7.42 2 Address: 3521 SW Car St Miscellaneous (service or feeder not included) Each manufactured or modular 67.84" 2 City/State /ZIP: Portland, Or 97219 dwelling, service and/or feeder Phone: (503) 245.7774 Fax:: (503) 244.4804 Reconnect only 67.84 2 Pump or irrigation circle 67.84 . 2 E -mail: Chandlerelectric @comcast.net • Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: Chanco Inc DBA Chandler electric panel, alteration or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 3521 Sw Carson St Additional inspection (I hr min) . 66.25/ hr . City/State/ZIP: Portland, Or 97219 Investigation (I hr min) 66.25/ hr Industrial plant (I hr min) ' 78.18/ hr Phone: (503) 245.7774 Fax: (503) 244.4804 Inspections for which no fee is 90.00 / hr specifically listed (% hr min) CCB Lic.: 171892. Electrical Lic.: c209 ✓ Suprv. Lic.: 688s _...„,...- ELECTRICAL PERMIT FEES Suprv. Electrician. signature, required: ,!t'f� Subtotal: f o of permit fee): Print name: DAVID W. CHAND s AND i Date: 2/14/12 State surc iew (12 (25 ° / %of permit fee): , 0,1/47 A i TOTAL PERMIT FEE: 6 . � '2 signature / C+` C/. t his permit application expires if a permit is not obtained within 180 • • Print name: DAVID W. " CHANDLER Date: 2/14/12 days after it has been accepted as complete. • Number of inspections allowed per permit. , • Mechanical Permit Application FoR (mien: usf: ONLY � City of Tigard RECEIVED Received Date/By: ' � ''� Permit No.: //L,) ,9 „.... Y,Goy 11111 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Phone: 503.718.2439 Fax: 503.598.19 Other Permit: EB 2 Plan Date/By: T I G A R D Ins Line: 503 2 2 Q� 2 Date ReadyBy: kris: RI See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information CITY OF TIGARD TYPE criliiidiliNG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction I ddition/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* l and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: q a b ii,e,„,,,_ (requires site plan showing placement) 46.75 City /State /ZIP: C Furnace 100,000 BTU (ducts/vents) 46.75 l.� Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 1 23.32 Z 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: I 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 3/14, �� _ lire J.-4," � Gas fireplace 33.39 . 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 I ❑ TENANT Chimney/1iner /flue /vent 23.32 23.32 Name: cPrs (4Mtk Other: Environmental exhaust and ventilation: Address: L , Q 40.....IL. i I f , , Range hood/other kitchen L v u � equipment 33.39 City /State /ZIP: \ E Clothes dryer exhaust 33.39 � � • Single -duct exhaust (bathrooms, �� Phone: r 0 / Fax: ( ) toilet compartments, utility rooms) , ( 23.32 2...32_ A.-APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 J Other: 23.32 Business name: ,- i � ,,,,,,/1� ��Dim, ____ Fuel piping: Contact name: 0) �/' Iw" [4/ $14.15 for first four; $4.03 for each additional Furnace, etc. Address: Q , t` 41.4 Agelid/ % Gas heat pump City/State /ZIP: . ,i / q'giv/e Wall /suspended/unit heater Phone: (St 6 /6 `9 4 ) Fax: : ( ) Water heater E- mail: Fireplace Range TRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* Subtotal 1� w♦ City /State /ZIP: �D •1O'Y Minimum permit fee ($90.00) k'2j .3,t., Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: !ZZ q , / State surcharge (12% of permit fee) C, TOTAL PERMIT FEE l, f 50 This permit application expires if a permit is not obtained within 180 Authorized signature: ap „ days after it has been accepted as complete. t . • Fee methodology set by Tri -County Building Industry Service Board , Print name: \ • l Date: Z`7 Z —1 Y tY 1: Building \Permits'MEC- PermiWPp.doc 09 /09/10 440- 4617T(11 /O2ICOMTWEB) 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. 1:\Building\Permits\MEC- PermitApp.doc 09/09/10 2 Plumbing Permit Application Building Fixtures RECEIVED FO,, r1FFI list.: ONI., Received ` """ � City of Tigard Date/By: / ! Permit No.: Cj III a 13125 SW Hall Blvd., Tigard, OR 97223 F EB 2 2 2012 Plan Review C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: kris: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK BUILDING DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. I Ea. I Total ® Addition/alteration/replacement , ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ® 1- 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: 12426 SW' Aspen Ridge Dr. Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: Tigard, OR 97224 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 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: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Rough -in for one new bathroom in basement, installing toilet, lay and shower Dishwasher 25.02 • Drinking fountain 25.02 Ejectors /sump 25.02 JPROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 Name: p- • , 1 (iA N I AS Floor drain/floor sink/hub 25.02 Address: 12 , �; • L i � J(� Garbage disposal 25.02 City/State /ZIP: t , , i Hose bib 25.02 Phone: (403 414-- 6'64i t Fax: ( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: p/ . , .. Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: r 4 Roof drain (commercial) 12.51 Address: 90 / G, `SO //Lit, Sink/basin/lavatory 1 25.02 25.02 City/State /ZIP: / v t 4. q9-00 , Solar units (potable water) 62.54 Phone: el 6 6 tit( Fax: : () , j Y /low Tub /shower /shower pan I 12.51 12.51 E -mail: Urinal 25.02 Water closet 1 25.02 25.02 CONTRACTOR Water heater 37.52 Business name: The Plumbers Inc. Water piping/DWV 56.29 . Address: 90 NW 150 Ave. Other: 25.02 City/State /ZIP: Beaverton, OR 97006 Subtotal 62.55 Phone: (503) 519 -6644 f Fax: (503) 684 -1202 Minimum permit fee: $72.50 q, 47,5 CCB Lic.: 177214 Plumbing Lic. no.: PB447 Plan review (25% of permit fee) State surcharge (12% of permit fee) c;;,' ,7a Authorized signature: � �' TOTAL PERMIT FEE A I ,, Z 0 Print name: Juda nes Date: ■ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete- •Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building \Permits\PLMU- PermitApp.doe 10/01/09 440•4616T(10 /02/COM/WEB)