Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit #: MST2013 -00080
T I G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2013
Parcel: 2S104DA13400
Jurisdiction: Tigard
Site address: 13043 SW CADDY PL
Subdivision: QUAIL HOLLOW - WEST Lot: 120
Project: Wilson
Project Description: Convert portion of garage to habitable space, approximately 117 square feet.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 1 First: 117 sf Basement: 0 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: 117 sf Value: $12,000.00 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
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains. 0 Catch Basins: 0
Bckflw 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 Tvpes Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3
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 SFA VB R -3 117
Owner: Contractor:
WILSON, LOREN G & BETTY M D & L QUALITY CONSTRUCTION LLC Required Items and Reports (Conditions)
13043 SW CADDY PL 5241 SE KING GEORGE CT
TIGARD, OR 97223 MILWAUKIE, OR 97267
PHONE: 503 - 348 -0480 PHONE: 503 - 593 -7150
FAX:
Total Fees: $846.42
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTFWt1ON: Or=r-• law requir -- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are -set forth in OAR
952- 001-0 0 through OAR 95 X01 -0 - 0. ou y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B •, /� ' Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicati fiECEf' ED
Residential C y FOR OFFICE USE ONLY
APR 0 20 13 Received t7- / ma y ^ r oil
City of Tigard Dat : Permit No.: Q CJ �t/KJ
13125 SW Hall Blvd., Tigard, OR 9R2a, , Plan Review
M Phone: 503.718.2439 Fax: 503.59 1 0.F TIGARD Date/B : Ai7J� a Other Permit:
ection Line: 503.639.4175 Date Read •' o Juris: ® See Page 2 for
I I I Ins p BUILDING DIVISION Notifi 1 ethod: V / / , Supplemental Information
Internet: www.tigard- or.gov
w/ �
TYPE OF WORK / REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
[g Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
($ 1- and 2- family dwelling ID Commercial/industrial Valuation: $ a go,
❑ Accessory building El Multi-family Number of bedrooms:
/
❑ Master builder ❑ Other: Number of bathrooms: /
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / p 0 f IV C 14 D1 y /P4 New dwelling area: /t square feet
City /State /ZIP: 7/ DetG , Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 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 ( rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
n
DESCRIPTION OF WORK work indicated on this application.
.4D0 gvie 00, 4 4/., p ostmeiC #M l y' �i ,fjtid Valuation: $
Existing building area square feet
New building area: square feet
] PROPERTY OWNER I ❑ TENANT Number of stories:
Name: JE/nr -A LoiLt . i'/f f0.rte Type of construction:
Address: /39 3 f z ,- C,4)/ / %, Occupancy groups:
City /State /ZIP: 7 /4dR, ex, Existing:
Phone: ( FD 3) /4 f- O Ikea Fax: ( )
New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to jee schedule)
Business name: DaL. 4 ',i /7y 6-,,m f -7�� 0,,- L LC Structural plan review fee (or deposit):
Contact name: •D,
� �/ f4 ,f/� 4. / C!^ z.af I c--7.- FLS plan review fee (if applicable):
—
Address:
City /State /ZIP: /1,01/Z I,, / E- �,e - 97 2 6 Total fees due upon application:
Phone: T 5'93 - 7 -, Fax:: ( ) Amount received: �� �/ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail: ✓oApry - # /',f,y,s, _ cLM
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mo a PhotoVoltaic Solar Panel System.
Business name: I 4" el'Pi� Submit two (2) se.. • roof plan with connection de 'Is
s� and fire department acce., : .ng with the 20 1 Oregon
Address: Solar Installation Specialty Co. ' ,eckl'
City /State /ZIP: Permit Fee (includes planre ' $180.00
and adminis • :. a fees):
Phone: ( ) Fax: ( ) State surcharge ' o of permit fee): $21.60
CCB lic.: 240F 17967 /R//7/ 3 To . fee due upon appication: $201.60
Authorized signature: This permit application expires if a permit is not obtained
.�f within 180 days after it has been accepted as complete.
{ / Date: 4...i_ * Fee methodology set by Tri -County Building Industry
Print name:
Dvy !�P`� I � 3 Service Board.
I: \Building\Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02/COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard R eceived Permit No.:
V 13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
l' I G A K 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 completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore_on and shall be shown to be ap to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non- impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(I I /02 /COM/WEB)
Plumbing Permit Application
Building Fixtures RECEIVED
C
ity of Tigard Received �/ / / permit No.: �" QZ
a 13125 SW Hall Blvd., Tigard, OR 97 R 01 2013 Date/By: 7 3 ��pt[// ��
Plan Review
11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 D ate Ready/By: Juris ® Se Page 2 for Pa
T1(;nRL) CITY4FTIGARD y y. g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF ;1 : Rlf' ING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I 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 ❑ Comercial /industrial SFR (2) bath 437.78
m
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: / 3 e 5 CAW >e ,L Catch basin or area drain 18.76
City /State /ZIP: / Drywell, leach line, or trench drain 18.76
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
� 4221 f)7,,/ Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 1- " P ' �L�1 Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory I 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet I 25.02
CONTRACTOR
Water heater 37.52
Business name: /174,1- 4 R * /.V ®lo. I'/," Water piping/DWV 56.29
Address: Po-7- lc S l I Other: 25.02
City/State /ZIP: 1.7-0..., n 2 9 ? -):3(g' Subtotal
Phone: ( f7 /) 3 4/,, v f r/r Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: / 96 9z 9 5114 (1 Plumbing Lic. no.: PQ I •)...-).� Plan review (25% of permit fee)
�} c/ State surcharge (12% of permit fee)
Authorized signaturepl �y 7 /� l T TOTAL PERMIT FEE
Print name: v 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.
L\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 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
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
El Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cl Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF - PermitApp.doc 08/04/2011 2
Mechanical Permit ApplicatRECEI V ED O
[(HZ ) 1 1(1 1 SE 0\1.1
City of Tigard 1 L Received Permit No.. c � _ •
14 . `J g Date/By: J,# , M
13125 SW Hall Blvd., Tigard, OR 97223 P Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 R 1 2 01 Date/By: Other Permit:
1 1 ci �1 li 11 Inspection Line: 503.639 /� Date Ready/By: kris: EI See Page 2 for
Internet: www.tigard- or.gov CITY OF TI GARD Notified/Method: Supplemental Information
BUILDING DIVISION
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
❑ 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. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /;e7443 , f i " C, Y p (requires site plan showing placement) 46.75
City/State /ZIP: Furnace 100,000 BTU ( ducts/vents) 46.75
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 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
/ Gas fireplace/insert 33.39
ft,1 ,14-h' AAP/7%,.' - 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 /liner /flue /vent 23.32
Other: 23.32
Name: !.t/' /L f®4/ Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 1 23.32
❑ APPLICANT 13 CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: A i efrdz l y e,,,, f7�veA z`, G Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: /, f 7j State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: A./' �� days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri - County Building industry Service Board
1:\ Building\Perraits \MEC- PermitApp.doc 03/07 /12 440-4617T (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.
1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 2
04/01/13 12 :57PM PDT Axis Electric -> 5035981960 Pg 2/2
... ... .. .. . .. . . . . .. • .....•. ,...... .• :•:. .., ....... ...... .
. ...... • .• •
,. E.ketrielltrerIllit•AppliCatiOn REc E •
,:„ NE ••• • - • • •-• • '
: City .of Tigard aixiiiit•No,! msvorionoso
,.. • batav • .
a . .
:: N '04' :'. .• 1:1TOSW Iasi:Pim., Tia* 91.27J --inirrii'gvaw ___ _,... . ,
Dtibl•Pirmiti
• V Pbvilv ..503,10.14 * . FrvF.: $01,:q98.10:60APR 0 1 2013 _thp‘igi . .. .. . , ... ... .. .... .. . .. .
. ..--
m ... :lbspecLitmitanc. i0:3.634417 • .r.mln R.:46'110y ' lwii. I S a .Scii:Plie 1.:Ibr
1 ; ,.
:::.■ • . .. kIttomtt 444010111,t5r.geir I 11 II, II 4, Z I ithatIsamoh■d, ii . .. .. . . . . _
• epoknntall
ueifindrainuit ' k, . ,
. . . .. .. . . . . .. .. . ....
h 1 •
ii tril HI lii 11.1111 1111 f 111111.1[1111117 1 1 ' , , :...477. - . , : 11111111111111B 1 11111111:1111,121iElii 111111111111J111.111
, 1 1 1 : 1 1O*460i.;0044160. Itil Additidtiddlietratioti/65placetnent pirokilibidijathk.ijoky on1hiitilldwoilitiOn0:067,4'cli4cktdtkidvit.
' 'CiSerdedcefeeder4004xtp* tsroadre: 'r,3Dalititttirover titree Morita. j
!I; • • aPea101iti011, 0 Otildr. wkira•thaiiiditiof fauiiii,theal E:11.4 ,i,,,t 1),.-01, 6
: . • ,
, ., ,,,,,, , ,,, , , , , , r ,,, , rt:11 , II . •
li coin If! 1 ., IN !, r p r , .1 ,:, , ,, •• , if , , „...,::,,, : I • 0, . j in , i thiit,ili'lidlilli HI 0 ial [H i II .0.ta.6 14,001.11TH 1111ME '1:1 Fi4411 balifillIV:
. , 1 ii*Iil 1 , 00 , Will lb Iii it t iduthliniAluirau I liO i i.411111111fillnli I i',11111 MU • •Iens: guund, nr•exmcds 14.D00 li cominemial.use ,irw il
wi
if! .. :.1 :® :.;0. h 1toolototioy t .ttitikistrioil nt atAttes4ory building • idea hr All oam. intiallaticas, bnildingt.
11 • ' •
.(1 Stilfiltmlil' ' .r] Alsto WdOi :in °Lbw:: : . jamtit rAehil 0 111,:tAliatioA or 76:.K vfvor:
9MIETIffig .r . ' 'I. ' '' .1 '''. ' . i d*
.,1 111111111t11 A il MI 11Ln 4414,040„.migiu ihil i
in , I .1 , ,, , , , :
l 1 i iilirrill7, 7 7,17 1 , , : tlervrvy iymun. largo 3nperntcly. darkiefiVitUai.
1 14; 141111iii .0 Addiad.d of nou motor load Of Ca'A'. : "E","1...let,'ItA.1 i ',
lob itn. '. .1.9b.SiW aids : 1310.40.51.V Coddy. Platue 10UHF oi nnto. PVInipnnny.
•CI.Ait "emort rw.00.04 110,11, allectIttionai veidele pa$4,
I:: . '. , • • . ..
1
il . . dity/State/Z11) Tigordijit
Sititgibldg,/*L:Thm • ,.. • • .. • • •
1 :itojectivont! 0 lirAltb-onn7 fecditicn.
C:;1 I' ba.Atdod toi:Arka.
0 Servicg nr kadas..c6 or, 0Siopply valtnge.•kir i310111thilll
.elgiFiiiAltiflifOilial:.
•
•
1 ,
MIS t17 site*
it
- • • . . . . . - _
" r!'4,r 1 i .11 lIgg gl g
! ! .1. • ,....i...ii,,,, ..4.... • •••• • , ,..,..1,, . •
. . Ei.40 - ftr.• • • • .:1111=111111113111
. New nemAtitti4knifirdwolitutuntt. ' ° - '
• - . . .. :Ittetedatattlehodgdotg.. . ,.._. . ... . .
•
i i • •Slibdiv.iSinii; 1.61: no.: .. 1,60.04q...(1,...orkse
;,____..__._- .._.- liaN
• : aladl Joaai.,ft..orptutaft 33:92 : 1.11.11110 .'\
1 :
• `17i.v.rnAtp/porcellio.!
Litiiiii:eneggy.:rettidio Ai.
111111111,,i INL
IJR1,11, iii ,, ,,,,, 1 . __IN■__/iiiiiiroitt lit',fc.). -
.4.: 1.olitAd 014rh5,1MAtinreifii/Y . . 7 • 2
. 1 .
q i . • •(;firAge.Addikiefipt : .cidet . ial wi h qhlyviirs4 . ; Al • ,
' ' • • • • •"" Services:or hedeitt Inllattai ..d1reriA101,•444/0* •
I i .*:t*.P4'.C 1 .0i.14i
LI
. .
• ' 1 1 - Ir .
l i . . !IIIIIIPI.! .. Lif„ ' nt„ 7r i r a.VigA gii I I ':!.. 4 . 1 . ' 1 ■.'.. ': i,. 7. 1 a ' ' I 4 e ll j ji ...:: 0 , itt;iii ., ...
.2..
'.20014 ?
.' 9 t
' : .. •
• ' • •" ' • . ' ; inifi, • 4l 4.. • 2
. . - .
Aildfm . ' 'OgOf i.,00.0:P00•40.4i1S. 11111111=11111111111111E1
. _
i• .. :city/stilt/2a: • . • • •Tempursryuriii.or:frodii*Iiiiii00t10
. . '. • ' •retsitsidun .
. . . .. .. _
•
. 4914 . • I
P11.0ii1C' l', .) U
:;,) • • • 2004ropt[0.1:40. • .
, ......_ _ . .. . . .. .. . . . . . .
„
In Antdged4nktro'
: '
Owner :InstoilliiitiOn: This instiligice is beillg;flinde bn Iwopt.-Ai_ dlit:I. own •whith ' t - "' - • ' ' ' ' • '' ° .. ' • • ' - 1:2 : . • . .. ., 2 .
• ..44140ipsti.1419*(000 . • : - 1191.941 . ' 2
Intetuded•for Atli:liaise. fent .ur anditutge stuUtnAing' 16 Oft.; 447, 449, 67(i Ind '70'1
•0 'Britaek limits -W .. -ilig .. .
iF . 0 4 #0 011, :041 1 :ature; • • . . . ..„ ...,..: • ..-, :' 1)10 . . • .A..liaiiiiiiiielvtikiiiii . -
iij 4 ft... :.:. -, ... 777 ... 77 ,, , • , . -,--.. - -., . •-•,..... ,- f ix,: : •
11111 IN I I 1 ii 11 11 Ill 111110111E co!NTA(.4 nam'•`' ..' -aD9T /44*er 14 X
. 1.... •• :••• eadh:brinth circuit . •
:•• . : . i .. .. . :
'.''• ' 844.401Ca4)14010i. • .fi:-.Tfile•-ficitteuits•tmthow. 11.
• 'Advice o &odor fai:/irt ..
i •
• : Conttio.I:Jtintir:: . .brAnch dredic • .
.
F...nnt•I ad '2 7.41 2
: • • Addres4:
. • • . 64.1 •sersice or feeder mat Includfd . - .
: . . : ' y '. • • l'AIC 11 11901113 rictUrfO.Will.0411411( •II
ci
. . . .: . &milli), gervi,. '... iiie • -: . .
:.. ••,.. - . ...• : • • • . . .. . . . . .. .
Piiffiliir. (
.' .) FAX.: : '
. .. Rsik'xilOokli . 111111111=3
:. .. '
. :P.Lop.:.witogitioiritirogi 67I4
:i. ' . ° :E-010■11:
: • . • .. .. . . .Sittkor oda* liolnid 1 .67 44 .
:;i : '' I 111 1111111111111M113 ' , , „ ,•,,,_,_, H ..' ,,'..1.;;1'1',.::!ii -- itnied . Oil.1104).VOlir■Idvd*IbCP. • . • ' ' ".
!, • fltu4iiic•ki .ndifte: Atli:0000e: 00,41001km, or eidAr;ttot. 'AI. • .:2 • 2:
.11i5kh•oddiel vigil A 44„116 .041 ' :.: iatilifiiiiblace • .•
...Addroa: 27KA,tor DR. • • A 1 iu:0
:Jim.l.i.A- .mg . 00 ii .• - . • ..
..... . 111
._,_.....
•
.
: :[,,ti in niio 11111 , ,46.24tiir . . .
City/Stat6 Lm 011:9.106.ti --
. . • • . • • .. . . . . . ........„.,..., ........ ..„_ - Trowro :pig* 1:4 1*(15. . 11111111EM .
....•
• :Phone: 04134•300.066 •($0:4).$949$9 Tspwictirf•;:tilei,Allieh.ra lite ilt IR • • • .. 0 _
90.001:14r
. • kAti led IY.iktodii5:(irtaitli ...• . • . • •
. . . . ... . . . . . .. . .
•
- teB:i.ic.z 20.74(Ad• Itletutivi(.1:3C-:...... 4 70 • • supry. tit::: 240$S 1 111 JPE111111111111$111;. ..... .. nr. ..... . I Ill 111MIll
.
. .. ..t. .,..,,, -, - ::sithbitiii:. • 114)1; •
• Suptv....tiortrjviaa sigilaaite, tow,c,u., • .., •• • • . • • • • 1111111001WAli .
PIORTqvierw ic..5$4 of {1enni t•fnet): :
..4-..- ..4
iP.aliL:Liame: Glary' West :.1:)3te: 04101/2013 .Stute.stitharge..(12%nr pontiff*:
,.. , . . ..:- •
• .. . . .... ... . , T,crfAI,:isriltfvfl.t#Itt:
: • AiSlio i.17*Wit.14141irei\ , jt v . s i k ,, .. T . ..
..; . . vi.oinioop n
ootio:o.iiiisaA:ioniktis 04.., ow.* ■Iitt!1!1:11
•
..
:110•10.0111 viireolotek..
'9* 14 NOilcie lilith .litl4N 04/U 1/24113 .. - Noinha
„ . . _.....
l'i •Iyeitkftiounkoric.p .00:0•4, 446-4 vomovont■
. :i
, ...
- - . , • -
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
05/24/2013 00:00
MST2013-00080
PASS
Previous corrections have been completed
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
280 Insulation
04/15/2013 00:00
MST2013-00080
FAIL
Provide electrical and mechanical approvals, all else ok
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
305 Plumbing underslab
04/08/2013 00:00
MST2013-00080
PASS
NOTE DWV rough/test with water
Also did footing inspection for contractor
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
399 Plumbing final
05/22/2013 00:00
MST2013-00080
FAIL
1. caulking required on fixture(s) at: toilet and lav 310.4/407.2
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
05/24/2013 00:00
MST2013-00080
PASS - No C of O
Previous corrections have been completed
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
615 Mechanical rough-in
04/16/2013 00:00
MST2013-00080
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
13043 SW CADDY PL, TIGARD, OR, 97223
Residential - Master Permit
275 Framing
04/15/2013 00:00
MST2013-00080
PART
Provide mechanical and electrical approvals
Violation Summary:
Inspector Contractor