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Permit
li CITY OF TIGARD MASTER PERMIT # COMMUNITY DEVELOPMENT Permit #: MST2012 -00273 T I. G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2012 Parcel: 2S 102 DC06000 Jurisdiction: TIGARD Site address: 13839 SW 90TH AVE Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 9 Project: Edgewood No. 2 Lot 9 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 4 First: 2116 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 17 Bathrooms: 3 Second: 0 sf Garage: 464 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 2116 sf Value: $239,969.68 Rear 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 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: N Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temo Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addl 500 sf: 4 201 -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 2116 Owner: Contractor: GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions) 19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503- 639 -4175 TUALATIN, OR 97062 TUALATIN, OR 97062 PHONE: 503- 692 -3390 PHONE: 503- 692 -3390 FAX: 503- 692 -5433 Total Fees: $16,173.10 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 nter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344. Issued By: i R th,�( J I .-( Permittee Signature: ! Call 503.639.4175 by 7:00 a.m. for the next available Inspection te. 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. B.uildin2 Permit Application Residential RFCEIVED FOR OFFICI: I. Sr 0\1.1 City of Tigard Received Date/By: tolaoft A- "'- Permit No./LSI 0.04?... 00 ?.-z3 ) . 13125 SW Hall Blvd., Tigard, OR 972'23 OCT 30 2012 Plan Review a Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ( (7(1 aher Pennit ,told- op gy Inspection Line: 503.639.4175 Date Ready/By: „ 63 See Page 2 for I !ARD Internet: www.tigard-or.gov CM Notified/Method: /y/7/f( ins„ 1 Supplemental Information BUILDINGD1VISION wori_ctif(1 difq ,... . . .. RN 1RED DATA: I..- ANDWAMILif"..liiitiirtaileM ) New construction 0 Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 0 Addition/alteration/replacement p ( paler: , , . . equipment, materials, labor, overhead, and the profit for the *...; • ... w„,a';;; ■., - ''':: , — €QJ ". ' •''.,..,!, ,:. r. work indicated on this application. -::'--'-'' ' "--- ''''' ' '''' — ' ' ' ' '''' Valuation: $ "2. 3 0 , 66 ( lil 1- and 2-family dwelling 0 Commercial/industrial Number of bedrooms: hi ) 6, 0 Accessory building 0 Multi-family 0 Master builder 0 Other: Number of bathrooms: 5 '.1'4:,:' i:. '. '' ,.:.::... -. : -. :'1, .:::::i,'.: Total number of floors: / Job site address: 1 1r3 7 .5 C,--1 I'D 14 New dwelling area: 27/, square feet City/State/ZIP: Tigard OR 97224 Garage/carport area: - feet Suite/bldg./apt. no.: Project name: Covered porch area: Cio square feet Cross street/directions to job site: Deck area: square feet Other structure area: 75 square feet 17 : : - 111EQUIRRIVIYATAirC0111 Subdivision: c:C7,e Z.-- ! Lot no.: 7 - Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map/parcel no.: 2. .376 2 4c. oCcero equipment, materials, labor, overhead, and the profit for the • " k -;' 7 4 -,' : l' ;• . ' * i. ' Z.:: ifiliiiiitail4 , ; ,- ' ' .'-:' f . - ' ' ' :' '', , . - . ',, ,'' ; ":;-:.; work indicated on this application. AZ Valuation: $ -6<.) /-(fr7 Existing building area: square feet New building area: square feet .. , . .. , , P. -3 7,4761,1110 111 40*****,;• - ; - idigia.::' , 41040k' - . ,,.:.-..:. , Number of stories: Name: 6 7 ...,,,,e......,_ c.,,,s,„,- 4 4. c . Type of construction: Address: //2_,7() . t',( te Occupancy groups: City/State/ZIP: --- ce , .; D/4._ '72 062-- Existing: Phone: ( 5253 ) .y., ._J i 0 Fax: (x 3 ) 61 S ce 33 New: ''''''Vr',.;1 . 111k*Iiiiimak :- ': ,.-; " ..s; . Et: coprAcr. 81611•111M41611,77 Mmdirliblrelliell0~ l_lilusinessname: 6, /-7-70„,/e Structural plan review fee (or deposit): Contact name: e 4„d ‘grot 1 FLS plan review fee (if applicable): Address: / zoo -fc4.,) liG af-C Total fees due upon application: City/State/ZIP: - 77 .44L i g. e.., .„,,, Oa— 97 0 C 2 — , - Amount received: "1,5 co Phone: ( 5 3) Con_ -3? f.'s Fax: : (St:13)4 f 2_- v3 1 : - ....BPITIMMOSMICSOild1113011111.49111.10.1*SIMItt ;,;,f;i E-mail: /ir-e ( i age/4 4 ,e_crAta, . ,, Commercial and residential prescriptive installation ot ?....-..,L7 .•.. 4, ;..;') , ' , ., ,v,r.p.rs. , , • -..W,....,<',„ ,. :,,c:. ; n:.. ' , :;7'.',. roof-top mounted Photo Voltaic Solar Panel System. Submit two (2) sets of roof plan with connection details Business name: Ge„,4-6_,_ A7,1; Oft...4r and fire department access, along with the 2010 Oregon Address: / 1 2-ao 5 C.c.) 4-1./6 1-4 Solar Installation Specialty Code checklist. Permit Fee (includes plan review 1 City/State/ZIP: 17■...q...6. -(t7,./ 071..___ T -7 496 2- $180.00 and administrative fees): r i Phone ( ) 4-2 '1'2 - ,? I P15' Fax: ( .)7%•3) G ■ ? 2 - 5' cz? 3 2, State surcharge (12% of pennit fee): $21.60 CCB lic.: .3' i t 3 szD Total fee due upon application: $201.60 Authorized signature f This permit application expires if a permit is not obtained :I ... I ....7 -__ This within 188 days after it has been accepted as complete. * Fee methodology ri-County Building industry ■ Print name: /9 ; Date: /04/22-- Service Board. set by T I: \EluddingTermits \BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical ,Permit Application RECEIVE City of Tigard Received 'l Date/8 �C// II s �i Permit No.: � f -- hr)47 • • 13125 SW Hall Blvd., Tigard, OR 97223 �C J 0 212 Plan Review (J(/ 14 C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: l3./i"7 1/ - tfrii Other Permit: T I G A E: D Inspection Line: 503.639.4175 CITY cipTin�D Date Ready /By: ` / fur el See Page 2 for ' Internet: www.tigaz � nn +i�ip� d- or.gov W o tified/Method : Imo`/ ( `il /c '—r( Supplemental Information �nv ., ..•rte. ,_..i..,: N construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/,tems checked below): ❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. where the available fault current ❑ Marinas and boatyards. F ' CAYE ey M i ' ° exceeds 10,000 amps at 150 volts or 0 Floating buildings. Z1a&�l .' �( p 1- and 2- family dwelling ❑ Commercial /industrial El Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural g amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or �. ['Emergency system. larger separately derived system. SQB ,7l R I R1 11: • ANIV..LQCATI N:.t ❑ Addition of new motor load of ❑ 'A" "E" "1 -2" °i -3' Job no.: I Job site address: / 3 g 3 7 5 f Q 100HP or more occupancy. ❑ Six or more residential units. ❑ Recreational vehicie parks. City/State /ZIP: - 7 4- .7 , 45 ,„Q &A.- ? 2 2 2 q ❑ Health -care facilities. ❑ Supply voltage for more than 6 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. ' PEE SC DZJIrE a Cross street/directions to job site: Description 1 Qty. I Fee. Total New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: .emCq / ,{ ...re - r e ic Z_ l Lot no.:? - 1,000 sq. ft. or less 1 168.54 4 Ea. add'/ 500 sq. ft. or portion i 33.92 1 Tax map /parcel no.: 2, S 1 Z B C b COO / „ G Limned energy, residential ` + • - 4 1 sib[ _ rigs -i s t n ; (with above sq. ft.) I 75.00 2 t / - e t "- ) /1 Limited energy, i fv s residential (with th above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 I 2 ti., t a -' : h 4 ..'' 01 . • 201 amps to 400 amps 133.56 2 ^ 401 amps to 600 amps ' 200.34 2 Name: C� .4t t 2_ N t 't (� 601 amps to 1,00o amps 301.04 2 Address: / i Z,Irb S C..S 'L ( -f Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: 774,...,,,( ,.1 Ore,. Q 6 Z relocation ?hone: (5116) C 72_ - 3 ?a Fax: (543 ) 6 1 _ 5 e�� 200 amps or less 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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 +fir above service or feeder fee, *AMU. 6- ` " 'L'] / :,' _� -. ` b ""'� O ' I ` each branch circuit 7.42 f 2 3usiness name: G �e.,,,tz.Cr�� ii-E- 4_4_ B. Fee for branch circuits without K I/ service or feeder fee, first 56.18 2 Contact name: t . A.) G Z .� z___ branch circuit � Each add'I branch circuit 7.42 2 Address: t1 1 44.) ij6 Miscellaneous (service or feeder not included) CityiState/ZIP: �C..4 6„...-6,,,a oil_ q 7 pG Z Each manufactured or modular I 67.84 2 dwelling, service and/or feeder 'hone. Reconnect only 67.84 2 ' (563) L 72- 3 f `� I F ax. $ d 3 G z' S L Pump or urination circle 67.84 I 2 k� E -mail: d', ,�, , c a ,:rFB . - � .� F . . _ . _ . -Ai , • Sign or outline lighting 67.84 2 �' Si ci rcuit(s) or limited energy , 3usiness name: n (, Aw „ f Cie cf�, Q.F. 04 e I Peel. alteration, l inspection Page 2 2 A v Each additional inspection over allowable in any of the above Address: 2 0'Z S(� dS ( eN �.~ 44 � Additional inspection ( 1 hr min) ' 66.25/ hr j� N / � n ` Q $' Industrial plant 1 i hr mm l 66.25/ hr City/State/ZIP: c.� GL 6 /4 1 p �,/ / / Industrial plant (I hr mm) 78.18/ hr 'hone: (SG3) U G d /2 L o Fax: (5 i VG8- 1Y/ ! on Inspections for which no fee is Q s it listed % hr min 90.00/ hr CCB Lic.: `[7 8 Y f Z Electrical Lic.: Cs - 5 ' Suprv. Lic.:Y .. i ;^hA ,. Subtotal: 'uprv. Electrician signature, required: p lan review (25 % of permit lee): 'tint name: , it ' - '' Date: 10/1 -f��_ State surcharge (12% of permit feel: i • r `. "OTAL PERMIT FEE: -tuthonzed signature: _. I This permit application expires if a permit is not obtained within 19a 'riot name: / Date: /D(F -f /? days after it has d per accepted as complete. /// Number of inspections allowed per permit. 3wWieg■armaa1Et.C- PermaApp.GOe 07/01/10 440- 46157(11/05 /COM/WEB Feb 26 13 09:09a BRIGHTEN ELECTRIC 5415497213 p.1 Electrical Permit Application vyl 5 - . H ) R 01.1.1( . r. t . s is 0 \ l .l City of Ti and Received g U 1 Z Date/By: Permit No.: )../0 13125 SW Hall Blvd, Tigard, OR 97223 Plan Review lig • Phone: 503.718.2439 Fax: 503.598.1960 O 2,---1 Plane; Other Other Permit: T I (A I l7 Inspection Line: 503.639.4175 v Date Ready /By: Jug I RI See Page 2 for Internet www.tigard -orgov NotifiecL Supplemental Information TYPE OF WORK PLAN REVIEW VED Pleas chec all that apply (submit a sets of plats wlflcros checked below): XI New construction ❑ Addition/alteration/replacemen ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ other: FFR 2 6 2 (113 where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION �-+1 t s exceeds 10,000 amps at 150 volts or CI Floating buildings. 1 - and 2 - family dwelling ❑ Commercial/industrial ❑ Ata et W Ices to grand, or exceeds 14,000 ❑ Commercial-use agrictdteral maps for all other oatollatiocs. buildings. Multi - family ❑ Master builder SING DIVISION ['Fire pump. ❑ Installation of 75 KVAar JOB SITE INFORMATION AND LOCATION ❑mergen system. larger separately system. ❑ Addition fncw motor load of ❑ "A ", "E E^", . " "1 1- 2 "", . "I 1-3 "«, , Job no.: Job site address: t001iP or more. occupancy. I f 7 ul 1 ( ! Y ri ❑Sec or mere residential units ❑ Recreational vehicle parks. /State/ZIP' •. �� t �) ❑ Health -care facilities. ❑ Supply voltage for mewed= Ci ty 1 1 V a p, GI - 1 2-� LI a ❑Harda minimal. locations. 600 volts imal. SuitelbldgJapt. no.: Project name: 6, co.\ Sk I&fest, i'1 ['Service o feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description t DM. I Fee. 1 Torsi I • New residential single- or multi- family dwelling unit. includes attached garage. Subdivision: I Lot no.: 9 1,000 sq. R. or less 168.54 4 / Ea. add' 1 500 sq. R. or portion 33.92 t Tax map/parcel no.: Limited energy. residential DESCRIPTION OF WORK (with above sq. fl.) 75.00 2 ,�/ r , y, Limited ener mu lti - f 75.00 2 C (.hQ.n�j e. e AC ( I ` a t C l Y `LL r- r h U ,V residential (with above sq. R.). _ J l ( Services or feeders installation. alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 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: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being trade on property that I own which is not 201 amps to 400 amps I25.08 2 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 ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 4� 2 each branch circuit Business name: B. Fee for branch circuits trirlrorr/ service or feeder fee. first 56_18 2 Contact name: branch circuit Each addi branch circuit 7.42 2 Addr : Miscellaneous (service or feeder not included, Ci /Statel2lP' Each manufactured or modular 67.84 2 b 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 Signal circuits) or limited- energy Business name: 6YC8 1 LT 1 F I._� l G LL .. panel, alteration, or extension. Page 2 2 �1 Each additional inspection over allowable in any of the above Address: p {ate,, ZZ3 j(7 Additional inspection (I hr min) 66.25/ hr I City/State/ZIP: S � � 2YS l 1-7- Sq Investigation (I hr min) 66 5/ hr V Industrial plant (1 hr min) 78.1 ti/ hr Pie: ( 5LL 1) 5 q - 12_1 Fax: (5W t ) 5I1 61— 12.- 13 Inspections for which no fee is 90.001 hr specifically listed (K hr min) CCB Lic.: 1 37_2_2_ Electrical Lic.: 3 y - 4 3C.l Suprv. Lie.: Li 69 ( 5 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: fe): Plel (25 %ofpermit permit f): Print name: �1'�� ' 0 Gt �G Date: Z ice 11 State surchurcharge a ( %of permit fee): �J TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it ban been accepted as complete. Num of inspections allowed per permit. 1:1IIuidingTerrr etltLC- PecmltApp.dec 07/01/10 440- 46I ST(II /05/COM/WF73 - ,dtrd - t - `�' GA-- 4 �/1 1cL, apput;itUUI1 k.ary or .i. rgard • Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for All residential systems combined •. $75.00 Check Type of Work Involved: ' Audio and Stereo Systems* ..Burglar Alarm [Garage Door Opener* ET Ventilation and Air Conditioning System* • . , 1_-_/ Vacuum Systems* 0 Other: Fee for each commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: 0 Audio and Stereo Systems E Boiler Controls 0 Clock Systems :;- 0 Data Telecommunication Installation • E Fire Alarm Installation HVAC E Instrumentation 0 Intercom and Paging Systems 0 Landscape Irrigation Control* E Medical E Nurse Calls E Outdoor Landscape Lighting* E Protective Signaling Ei Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \BuildingTermitAELC-PermitApp.doe 07/01/10 Mechanical Permit ApplicationD , E!VED FOR OFFICE USE ON t.) �A. Re ceived / / � lit . City of Tigard Date/By: l • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ) (� Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 O C T 3 0 2O 12 Date/By: ( l Inspection Line: 503.639.4175 Date ReadyBy: luris: ® See Page 2 for TIGARD p C ITY OF tA0-7 1, c( j7 Supplemental Information Internet: www.tigard- or.gov N otified/Method: I BIIII DING nrvISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work New construction ❑ Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Demolition 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 Heating/cooling: - JOB SITE INFORMATION AND LOCATION Air conditioning Job site address: / C 13 ' 3 G Sc..) S o (requires site plan showing placement) 46.75 ? Furnace 100,000 BTU (ducts vents) 1 46.75 City /State /ZIP: 7 et.�, - C/2.. Furnace 100,000+ BTU (ducts/vents) 54.91 Project name: Heat pump Suite/bldg. /apt. no.: J (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 1 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 L c.T _ _ /, Z Lot no g O ther Flue/vent for any of above 23.32 � Subdivision: S � 23.32 Tax map /parcel no.: 2 5 16Z 4 G 6 G CZT6 Other fuel appliances: DESCRIPTION OF WORK Water heater ( 23.32 �/ '/ te� Gas fireplace /insert 1 33.39 Y W �61 Flue vent for water heater or gas -- fireplace fireplace 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 . Chimney /liner /flue /vent 23.32 1 PROPERTY OWNER ❑ TENANT Other: ) 23.32 Name: , .e Co N s--e- de) (#4.4.- , Environmental exhaust and ventilation: Range hood/other kitchen J Address: / 701) 4. ,-.(6,. �4 // equipment l 33.39 City/State /ZIP: -1; ( f t a O2 ) ° to L- Clothes dryer exhaust ( 33.39 Single -duct exhaust (bathrooms, �/ Phone: ( spa ) 4,T 2. - 3 3 Q 6 Fax: (5 )4• Z-- SY 3 3 toilet compartments, utility rooms) l 23.32 f a ❑ CONTACT PERSON Attic /crawlspace fans 23.32 �' 4%.„,..(2..._ Other: 23.32 Business name: / 6 , . s f d ( c.y Fuel piping: Contact name: i t,`,,,5 ( le..--(7___ $14.15 for first four; $4.03 for each additional Furnace. etc. I Address: `7 Z � sk? Yt! .. Gas heat pump City /State /ZIP: 7,. iLa_� „J ©A ! 7CC Z— Wall /suspended/unit heater V Fax: : ( spa ) 61' 5!3 Water heater Phone: (�j03 44 L- 3 3 1 Fireplace I E -mail: /..,e ,,) @ Gq•,'fLC o , cZti•-7 Range COIVI ACTOR•. Barbecue 6466 oA( � f Other: dryer (gas) Business name: Q p �a �, `�J Address: Pr C) 6 �1< g Z 1 f {p ( v MECHANICAL PERMIT FEES* d � 8 Subtotal City /State /ZIP: V4 Fr a oca t.,t e � 4 ( ` Min imum permit fee ($90.00) Phone: (503) G SS - 6 21( Fax: (913 ) G 56 - 2113 Plan review (25% of permit fee) CCB lic.: Yz sl o State surcharge (I 2% of permit fee) TOTAL PERMIT FEE / This permit application expires if a permit is not obtained within ISO Authorized signature: f /l/ days after it has been accepted as complete. f '- Fee methodology set by Tn- County Building Industry Service Board Date: /e01(2--- �/e01(2--- I Print name: C 1�fi Z� ... _ / ,.., ..._ ,.,� + +40- 4617T(11 /oLCOM/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- PerrnitApp.doc 03/07/12 2 lumbin2 Permit Application uilding Fixtures RECEWIlliumssell=11111111.1 City of Tigard OC 3 0 2 0 ' t / 0/3 ( a- 5-C Permit No.V4,14 - ppd. 73 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review , .., I ') , I , _. A • Phone: 503.718.2439 Fax: 503.598.1960 V a te/By: t CITY OFTIGA a ' at . See 1 i I 1 04 - 1) Other Permit No,: Inspection Line: 503.639.4175 i 6 A It. D ta Read RIM: ,.._ fa See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISI ii Y e ri3 th Y o . d: .9- ( ' /. S.T - e...7 Supplemental Information v craiite; '-'.. .,..,,i..'Z. .. , New construction (t E Demolition For special information use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement 0 Other: New 1- 2-family dwellings ;includes 100 ft. for each utility connection) ..... SFR (I) bath i 312.70 SFR (2) bath 437.78 1- and 2-family dwelling X I 0 Commercial/industrial SFR (3) bath ( 500.32 Accessory building I 0 Multi-family Each additional bath/kitchen 25.02 Master builder t 0 Other: Fire sprinkler ( sq. ft.) Page 2 '(4.171?ti.Ii''Ic"..frilintitatiki .. AtrOlaiiiitiggeTTI, - ' '. ' 7 :.,,- _Site ufilities: ) r3f 5.- O 467 Catch basin or area drain 18.76 site address: r3 pJ Drywell, leach line, or trench drain ' 18.76 .y/StateiZlP: -- ■64i---st 04--- Footing drain (no. linear ft.: ) Page 2 he/bldg./apt. no.: v I Project name: Manufactured home utilities 50.03 oss 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 :bdivision: .' ,4. e „rev c_t 2--- I Lot no.: 5" Fixture or item: ix mapiparcel no.: Z $ /C• a ,6 c. OC Cree Backflow preventer 31.27 .;.!'''",i'ii•-• ,-....': : , - , . _ - Backwater valve 12.51 r.I. . Clothes washer 25.02 lq-e44.1 14,sike_ Dishwasher ....F 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 *ii='!:si 771 rin_a a ., 3!"t"M.',*!k.l'aiMillar.,' , T . ,"'?e7 3 i iar' 4 ,,',LigialiTa:: , . :._.: .: ., - _ ', ', 7,4 Expansion tank 12.51 •!..; it .if 'if' '.43iiiiiy:ii.,l;.:0 fftwalbio.s..„11$1,,A ' r‘da ', ., . ,, a a•Nraaral. . Fixture/sewer cap 25.02 e: 6 e, CA Ai At- G bt.,_, Floor dram/floor sinluhub 25.02 Lcidress: / 5' 2. CI el 1%4-) i .11 Garbage disposal fr'-' 25.02 :ity/State/ZIP: -1 41 Oa. ?)O 4 2- Hose bib 25.02 0.-- 'hone: (Sa 3 )6f 2 - 3 9 6 Fax: ( 60PG, ?2-5 ce 3 3 Ice maker ai 12.51 '!.':,•isig4 Interceptor/grease trap 25.02 ;,:*‘,"-• - :„:14swi ''tbissai,i'hf■Pigli■glitAk'',,,P,A4trcioroEikai,;',.k.:,...tm,„tet:ivonsbaliwortr. - '. Medical gas (value: S ) Page 2 3usiness name: v. Czussi-- dr (..-e._ Primer 12.51 .:.)ntact name: /4....; 6 e /47 Roof drain (commercial) 12.51 Address: // 2_ CS 5 Cc.) i j 4 4-47 Sink/basin/lavatory ,' 25.02 2ity/State/ZIP: --1 4. (A.-6, 4 4, q ) 66 ' 2- Solar units (potable water) 62.54 ?hone: (5 ‘ q2_ - 3 3 go Fax:: (5 ‘ ?)-- ,5-i133 Tub/shower/shower pan 12.51 Urinal , 25.02 E- mail: (*PK vgd , G4.10, Water closet - 1 25.02 . • 4k-tAll••-••••, ... .ii:s:,..,,,, ' ' -."'''■' .. Water heater 37.52 --, Business name: --IZA...„, .Ar f p ( t 4 ... I" / ,ay Water piping/DWV 56.29 Address: P 0 73 0 ?„. 2 - 7 '{ Other: 25.02 City/State/ZIP: (4) t s -f• 4 ,- „,,, Oi4 /7 e,C43 Subtotal ?hone: ( 563 ) S5" 2 ... 7 5 g 5 - - I Fax: ( St1 3 )4%1- (IL! 2 - . Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: I b3 211_ i Plumbing Lic. no.: 32 T Pet . State surcharge (12% of pemut fee) Authorized signature: -" / / TOTAL PERMIT FEE .... .. / Print name: 11 1r - - Date:' ir 1 This permit application rapine if s permit is nit obtained within 180 days after at has been accepted as complete. _ __ a% 'Fee methodology set by 1 Building industry Service Board. : \BusidanoPermrts■PLA4U-PenasApp.doe i 0/01 /09 440.4616TO 0/07JCOWWEBI rage 2 - Supplemental Information . . -., Fee Schedule: - Residential tel:. t$e :. ;,; :; >:�� i enha Fire Su ression S stems: Footing drain - 1' 100' 1 ; r a , , t 50.03 ". _- „�f Jit - Its: , .i;,.! 1 -=1:1= ;.*. :: . - Footing drain - each additional 100' 0 to 2,000 $121.90 : _Ilign _ 2,001 to 3,600 $169.69 Sewer - 1st 100' 62.54 3,601 to 7,200 Sewer - each additional 100' ®_ 7,201 and - er $233.20 Water Service - 1st 100' _ 62.54 Water Service - each additional 100' Me as S st 37.52 Storm & Rain Drain - 1st 100' _ ' t.' G ! `'`' : 1 . C , a� , • Storm & Rain Drain - each additional 100' $1.00 to $5,000,00 "' s -- "S' �� `r ` °' _ ® $5,001.00 to $10,000.00 $72.50 for the _ ,000.00 Minimum fee first $ 5,0 first $ or and $1.52 for ti 87lR`' a o , QBS EX ; . each additional $100.00 or fraction thereof; to Inspection of existing plumbing or for and includin: $10,000.00. which no fee is specifically indicated ■ 90.00/hr $10,001.00 to $25,000.00 $148.50 for the fast $10,000.00 and $1.54 for minimum char:e — 1/2 hour) ■ each additional $100.00 or fraction Inspections outside of normal business 90.00/hr and includin: $25,000.00. thereof, to hours minimum char:e — 2 hours $25,001.00 to $50,000.00 $379.50 for the fast $25,000.00 and $1.45 for Reinspection Fees 90.00/hr each additional $100.00 or fraction thereof, to Additional plan review for revisions - 90.00/hr - $50,001.00 and u $74 . o r _ $50,000.00 P $742.00 minimum char:$— 1/2 hour for the e fi firsst $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. • 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 *. Fixture. �.�, for aatlty by Fl=turm')t:vne r w perfumed; Ca Aeplaee{ .�I,^ I • ':� i1 . 1: , w y � PPed Added Relocate Plan review is required of the following. R, 9aatistry /Fom Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and „lac uuUWhirl ool greater, except systems designed and stamped by licensed Car Wash -Each Stal -Drive Thru engineer. Cus idor/Water As irator ❑ New exterior plumbing site utilities for any complex structure Dishwasher - Commercial as defined in OAR918- 780 -0040. - Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Founta ❑ Any multipurpose fire sprinkler system. Eye Wa ❑ Any complex structure as defined in OAR918- 780 -0040. Floor Drain/sink 2" - 3" Submit seta of plans with any of the above. - 4" Garb Car Wash Drain a' Votiu a 'ica + �,. age •Domestic -non -food • Isometric or riser diagram required . •. ' s Disposal -Domestic related agram is re uired f or new buildings -Commercial -food related that meet the • ualifications above. Industrial -food related I • ce Maeh,/Ref i , Drains Oil Separator (Gas Stat ion) Rec. Vehicle Dam Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav - )sion -food related - Bradley - Commercial -food related -Service Swimming Pool Filter washer Clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs, a sewer permit will be issued and eater Closet Toilet fees assessed for the sewer increase must be paid before the Urinal Other Fixtures: plumbing permit can be issued. http : / /www, tigard -or. gov/ city_ halUdepamnents /cd/docs/PLMF- PennitAppzdoc :I ■ Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No.: M SI „,10/a - 00 a 13 Site Address: / 38' 3 90 ni Project Name & Lot No.: �D� E' Ci4 a- , Ler a t CWS Service Provider Letter Required: Yes ❑ No a Received: Yes ❑ No ❑ Routed Plans: Original Plan Submittal Date: (0/ 413 (( y 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. Planning Review (contact C1')ery/ ea M eJ' at 503 -718- a? q3 7 or Ch e) IC- @tigard- or.gov) Land Use Case No. '1°4)7 - vo °I 3 Zoning R- 4 • 5 Setbacks: Front .2 0 Rear i 5 Side S Street Side 15 Garage a D ❑ Maximum Building Height: .3 O Actual Building Height 17 pi Visual Clearance p Easements I Sensitive Lands Type: N/A P ir Street Trees p i Protected Trees - ti o rse- e r+ 411 s S i -1-C, Notes: Original Plan: Approved Not Not Approved ❑ Date: ) I I -- /- 4 1 - I Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) i� Actual Slope: 5' Notes: Original Plan: Approved Not Approved ❑ Date: / ( Z 1/(2 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 Applican Okay to Issue Permit: Yes No Date Routed to Building: • Page 2 of 2 November 29, 2012 RE: NEW RESIDENTIAL Project Information Building Permit: MST2012 -00273 Class of Work: New Address: 13839 SW 90 Lot Number: 9 Area: 2116 Sq. Ft. Stories: 1 Builders Name: Gertz Homes Subdivision: Edgewood 2 The plan review was performed under the State of Oregon Residential Specialty Code (ORSC) 2011 edition. Please respond to conditions below. 1) Braced wall line shall be no more than 4ft. from south wall of bedroom #2 and bathroom. ORSC 602.10.1.4 When responding, provide an itemized letter stating in what way each numbered issue has been addressed in the revision. When submitting revised drawings or additional information, please attach a copy of the City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard in tracking and processing the documents. Respectfully, Dan Nelson Senior Plans Examiner (503) 718 -2436 dann @tigard- or.gov 1 111 ' Building Division Development Code Provision Review I c ' `1 R " Residential Projects Building Permit No.: M 9(010; " 00 a 73 Site Address: / 38 3 90 ni Project Name & Lot No.: ; )0P a - , Ler a CWS Service Provider Letter 1 ( ; .:1 I1 4i t y Required: Yes ❑ No FY b 1 "p Received: Yes ❑ No ❑ l (!/ K1 ✓ 0 Routed Plans: ° !' S v t / Original Plan Submittal Date: 10/ 3 0 (I 2 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 (1) 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 Cheri/ ea in el at 503 -718- c:2 3 for Ch en /C— @tigard- or.gov) Land Use Case No. SU.5 Q0 -1,00 3 Zoning R - 4 - 5 p sii Setbacks: Front 0 Rear I 5 Side ✓c- Street Side 1 .5 . Garage a 0 ❑ Maximum Building Height: .3 o Actual Building Height 1 JZ Visual Clearance q Easements Di Sensitive Lands Type: NCR P r Street Trees Protected Trees no nL a v, -}1.11.r 5 i -1-G Notes: Original Plan: Approved Not Not Approved ❑ Date: • I I -- E21 - I Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) AM' Actual Slope: Notes: Original Plan: Approved Not Approved ❑ Date: l ( Z q/(Z 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 Applican Okay to Issue Permit: Yes No Date Routed to Building: Page 2 of 2 0 ley. 211 S 8 7°1 1 , 46 " E ? 81.91 Elev. 208 I `er♦ Wate l 1 15 -0 I Evian.. 'Vv 0 01111 PATIO 1 �I1 CJ1 I I Elev. 1210 I3.„ :-.1 0. (.n to I ii i STORM 'o v m o .:.�QCi. 1 O i O — 1 1 Elev 206 _, Elev. 209 Ilan -- N I\) .- : ,,,,-- j n O iit C 1,1 a 1 /, s \O 9y 0$ _% • I / "/ ) • I / ;o I / / O' `C.' 64 / / \ O. I '\ // / I ; / / t, 01 �p / Drive 13 0-) O7 �� ` f or Erosion I y mod' -N �� ; 1 '' I I •O O J — I I I ' I Of I I Elev. 209 C) c� L L 9° 8 N V Elev. 207 RECEIVED 1 I a Street trees ®car 3 % z Tilia Ameronana 2" m1� BUILOING GER CONSTRUCTION COMPANY HOME SQUARE FOOTAGE INC. MAIN FLOOR = 2116 SQ.FT. BUILDING / \ UPPER FLOOR = 0 SQ. FT. CUSTOM HOMES SINCE 1977 (503) 692 -3390 ,N� TOTAL = 2116 SQ. FT. 13839 SW 90th GARAGE = 400 SQ.FT. Lot 9 EDGEWOOD 2 SCALE 1" = 20' GERTZ CONSTRUCTION COMPANY INC. PLOT PLAN 10/29/12 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13839 SW 90TH AVE, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical final 06/17/2013 00:00 MST2012-00273 FAIL Add A/C to permit Provide nameplate for dryer duct run Fireplace not completed Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13839 SW 90TH AVE, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing final 06/17/2013 00:00 MST2012-00273 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13839 SW 90TH AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 06/17/2013 00:00 MST2012-00273 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 13839 SW 90TH AVE, TIGARD, OR, 97223 Residential - Master Permit 280 Insulation 03/20/2013 00:00 MST2012-00273 PASS Violation Summary: Inspector Contractor q CITY OF TIGARD MASTER PERMIT III Q , COMMUNITY DEVELOPMENT �� Permit #: MST2012 -00273 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2012 Parcel: 2S102DC06000 Jurisdiction: TIGARD Site address: 13839 SW 90TH AVE Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 9 Project: Edgewood No. 2 Lot 9 Project Description: New SF. (/17/13, reprinted to add a /c, placement of a/c unit must comply with manufacturer's clearance requirements. ` — BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 4 First: 2116 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 17 Bathrooms: 3 Second: 0 sf Garage: 464 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 2116 sf Value: $239,969.68 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell -Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 4 201 -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 +ampNolt: 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 2116 Owner: Contractor: GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions) 19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 -4175 TUALATIN, OR 97062 TUALATIN, OR 97062 PHONE: 503- 692 -3390 PHONE: 503 -692 -3390 FAX: 503 -692 -5433 Total Fees: $16,225.46 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 ' • - • • = • ce 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 I- , requires you to follow the rules adopted by the Oregon Utility • .- - Center. Those rules are set forth in OAR 95 1 01 -0010 through OA' • • -08 • . 0. You may obtain a copy of the rules or direct questions to OUNC • 03.232.1987 or 1.800. .2344. Is- ed By: j -- -..i1. _ � � ,' Permittee Signe'• e: //' l Lei`'r (/ /�J .,!--L--- Call 503.639.4175 by 7:00 a.m. for the next available Inspection d. This permit card shall be kept in a conspicuous place on the Job site until c. pletion of the project. Approved plans are required on the Job site at the time of each Inspection. Mechanical Permit Application FOR OFFICE USE ONLY � " Received / �, III City of Tigard : + Date/By: `�� -�� Permit No. �5 r /'- -."=)c;•;7 ; ° 13125 SW Hall Blvd., Tigard,OR Plan Review C Phone: 503.718.2439 Fax: 503.5 ` 8.'' -'j Date/By: Other Permit: f I GA R D Inspection Line: 503.639 UN 17 2013 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information CITY OFTIGARDD TYPE OR.r ®I1{IIO�e COMMERCIAL FEE* SCHEDULE - USE CHECKLIST , Mechanical permit fees' are based on the value of the work 1:1 New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 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 I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: 2p2 C ,� \ Air conditioning 46.75 Job site address: / > D J ? 3 c(Q - Furnace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: Fumace 100,000+ BTU (ducts/vents) 54.91 Heat pump 61.06 Suite/bldg. /apt. no.: Project name: Duct work 23.32 Cross street/directions to job site: 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 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map /parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 A—S2D n fli vent for water heater or gas r �l -} � � fireplace lace 23.32 l/ Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 0 PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City /State /ZIP: Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 Phone: ( ) Fax: ( ) Attic /crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four; $4.03 for each additional Contact name: Furnace, etc. Address: Gas heat pump Wall /suspended/unit heater City /State /ZIP: Water heater Phone: ( ) Fax: : ( ) Fireplace Range E -mail: Barbecue CONTRACTOR Clothes dryer (gas) Business name: Other: MECHANICAL PERMIT FEES* Address: Subtotal City /State /ZIP: Minimum permit fee ($90.00) Phone: ( ) Fax: Plan review (25% of permit fee) ( ) State surcharge (12% of permit fee) CCB lic.: TOTAL PERMIT FEE - 340 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: " Fee methodology set by Tri- County Building Industry Service Board Print name: / - e a - ) Gee A - _ Date: I:\ Building\ PermitsUMEC_PermitApp_040113.doc 440 -46 t 7T (I 1 /02/COM/W EB) 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:\ BuildingTermits \MEC_PermitApp_040113.doc 2 STREET TREE T[GARD CERTIFICATION I, /51Ac) Ld , owner/agent for e.4.3-2_ A% , (PLEASE PRINT) (PERMIT HOLDER) do hereby certift 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.: //1157--- 2_0/7-- 0° 73 HIE ADDRESS: /3 '39' • -t,t, go T`�, 0 DL SUBDIVISION: LOT#: / SIGNATURE: /AI / L / DALE: J3 (OWNER/AGENT) ` RECEIVED & VERIFIED BY DATE: l ( ! ' )OF TIGARD) I ❑ Tree location verified per approved site plan. I:\Building\Forms\Street freeCertificate 05/30/2012 Oregon Residential Specialty Code N1107.2 HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: Jurisdiction: m5 zo/2-ooX73 • 77y, Site Address: / s-(4-) 9677+ Subdivision/Lot#: FA, and/or Map and Tax Lot#: 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)1 4 Signature: 1,(. Date: #a,_59 • ner/General Contractor/Authorized Agent Print Name: B121,4,6 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. 1:\Building\Forms\RES-HighEfficiencyLighting.doc 07/01/08 I . Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, eL 12-CAJ C. , am the general contractor or the owner-builder at the following address: Site Address: /3 j 7-/') /44'e- • City: -r- Permit#: v72 2D/Z ' 607_3 Subdivision/Lot#: # and/or Map and Tax Lot#: 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. Signature: r / Date: b/�//� General Contractor or Owner-Builder / IA BuildingWorrn\RES-MoistureSensitiveWood.doc 09/25/08