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Permit u CITY OF TIGARD MASTER PERMIT r III I COMMUNITY DEVELOPMENT Permit#: MST2015-00015 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2015 TIGARD Parcel: 2S103DA05900 Jurisdiction: Tigard Site address: 10590 SW COOK LN Subdivision: FANTASY HILL Lot: 13 Project: FOSTER Project Description: 800 sq.ft.ADU addition. ADU address is 13475 SW Watkins Ave.4/6/16, REPRINTED to add ductless mini split&pigtail for electrical connection. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22 Bathrooms: 2 Second: 400 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 2 Third: 0 sf Right: 16 Detectors: Yes Total: 800 sf Value: $90,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 40 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 1 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'l 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 15 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: ACS SF VB R-3 800 Owner: Contractor: FOSTER,SCOTT A&LORRI K PREMIER PLUS CONSTRUCTION Required Items and Reports(Conditions) 10590 SW COOK LN PO BOX 441 TIGARD,OR 97223 HUBBARD,OR 97032 PHONE: PHONE: 503-951-2215 FAX: Total Fees: $3,835.63 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0through••••R 95 t•• 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5r.. 32.1987 or 1.800332.2344. Issue By: IjL �_�%_.I i/��I Permittee Signatur --..I�� t !!'4 .� / Call 503.639.4175 by 7:00 a.m.for the next available inspection 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. xt CITY OF TIGARD MASTER PERMIT ''! B . COMMUNITY DEVELOPMENT Permit MST2015-00015 T I GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2015 Parcel: 2S103DA05900 Jurisdiction: Tigard Site address: 10590 SW COOK LN Subdivision: FANTASY HILL Lot: 13 Project: FOSTER Project Description: 800 sq. ft.ADU addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 22 Bathrooms: 2 Second: 400 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 2 Third: 0 sf Right: 0 Detectors: Yes Total: 800 sf Value: $90,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets. 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 40 SF Rain Storm Sewer: 0 Tubs/Showers: 1 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: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Tvees Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fumy=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvciFeeders 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: 14 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 Ecompasing: N Other: N Other Description: P 9 BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ACS SF VB R-3 800 Owner: Contractor: FOSTER,SCOTT A&LORRI K PREMIER PLUS CONSTRUCTION Required Items and Reports(Conditions) 10590 SW COOK LN PO BOX 441 TIGARD,OR 97223 HUBBARD,OR 97032 PHONE: PHONE: 503-951-2215 FAX: Total Fees: $3,663.93 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, •r if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification • r Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of th-`ri u�•r direct questions to OUNC by calling 5• T j' •r .:r x.332.2344. Issued By: �i�� . - .-- ` Perm -e Signature: • I`II Cal 41".171111r75 by 7:00 a.m.for the next available inspection•ate. 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. r � Builclina t Permit Application RBSldential it F OR OFFICE USE ONLY City of Tigard RatnVe DaterB;. : �No.:Ala ` S . 13125 SW Hall Blvd.,Tigard,OR 97223 plat Reh dew .It Phone: 503.718.2439 Fax: 503.598.19 %..8 % /CO t}atci y: r�' �� Other Permit: I 1,,A};1, Inspection Line: 503.639.4175 v �`s Daze Ready/:y: Loris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method " Supplemental Information AN N° � IS101 r "f 4I. ,f^ •REQUIRED DATA;I-AND 2-FAIFDpr DWELLING ❑New construction r Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the k.'v ,tili ' e' UCTION .? work indicated on this application. ❑ 1 and 2-family dwelling El Commercial/industrial Valuation: 9i. (�" 6 C Accessory building El Multi-family Number of bedrooms: 2 ❑Master builder ❑Other: Number of bathrooms: 1 ,S"' ':,° M ,} JOB SITE INFORMATION AND LOCATION Total number of floors: Z Job site address: 1 bs-S c ••C'0.-1 CO O k Z R+.i.E _ J New dwelling area: 8(QQ square feet City/State/Z1P: -T( (�1 AR Q e (J 9 7 'Z' Garage/carport area: square feet Suite/bldg./apt.no.: Project name: / -0 0 FJjs Covered porch area: el' square feet Cross street/directions to job site: (NAT IC l N5 Deck area: n S' square feet Other structure area: square feet - REQUIRED DATA^ppMMERCIAL-USE CHECKLIST Subdivision: FolN-)-Iq•sy /4,4.4.. Lot no.: a Permit fees*are based on the value of the work performed. I - Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the 3,' 7. : DESCRIPTION OF WORK work indicated on this application. t Valuation: S 'f1001".)1 AO U : r° S`TiCcJCTU Existing building area: square feet New building area: square feet { _,' 5 PROPERT1f'•'OWNER I. ❑ TENANT Number of stories: -Sc car ris Type of construction: ress: 'os-5i O SCE C o D IC '4.4 l t Occupancy groups: .ty/State/ZIP: 'r-161 Asp O R 9477_Z3 l Existing: Phone:(JILT) 9�r5_�Z e Fax:( ) r New: APPLICANT ❑'CONTACT. PERSON ':BUILDING PERMIT FEES* r '`" '' (Please refer 10 fee schedule) 1� Business name: Structural plan review fee(or deposit):Oil • Contact name: ,..544)EFLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: — Phone:( ) Fax::( ) Amount received: E-mail: ;P VOLTAIC SOLARPANEL SYSTEM EES* ' i"C.J'" CON'�AACOit'";.: - Commercial and residential prescriptive installation of • ��;�� ``� ,. ;,_ ;* roof-tap mounted Photovoltaic Solar Panel System. f ket�1�!+ C.-., Submit two(2)sets of roof plan with connection details Business name: �-V vGT� and fire department access,along with the 2010 Oregon Address: --��1G 99/ Solar Installation Specialty Code checklist. City/State/ZIP: �j e9 (> ax- fie 3� Permit Fee(includes plan review S180.00 Phone:LSb ) / and administrative fees): 3 96.-( Z7.I Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Be.: i 80 S 6 / Pa /� Total fee due upon application: $201.60 et L Authorized signatu it This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: _, Lon- • 5Q` Date: / / 1 *Fee methodology set by Tri County Building Industry I Service Board.:I Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-Iul3':'(Il/0:/COsI'WL•'l3) Electrical Permit Application RECEIVEP 1.(M (1l I I( I. I SI O\I.1 Received City of Tigard Date/ Permit#: 1111111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503.598.1960 FEB 3 2015 Date/B Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: orris. ® See Page 2 for r I`' i,11 Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WO�I* 1 Y U l ll;4�ltl) PLAN REVIEW ❑New construction IAAddition/alteraglA�DIVISIIJN Please check all that apply(submit 2 sets of plans w/items checked): ❑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 at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: /OS-50 S(.% C ;2 (' ( A,.4 I00HP or more. ❑ A„ E„ 1.2> 1.3„ City/State/ZIP: 9! '] ❑Six or more residential units. occupancy. ty ` �� 0 7 7 v� ❑Health care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: 4 fJ v ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Imo' ✓ �� Description I Qty. I Each I Total I " ! ( New residential single-or multi-family dwelling unit. Subdivision: PAIN/ V y 14 c.` Lot#: /3 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less ' 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 //`` DESCRIPTION OF WORK Limited energy,residential 75.00 2 Cc,rn P�TC tj/l /K 1/1IG, U F , -o u Li(with above sq.ft.) _ .mited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: S(v-7-7-- ,3-Fit_ 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This i, tallation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,le. -, e r,,,or exchange,ange,according to ORS 447,449,670,anti 7 1. 201 amps to 400 amps 125.08 2 Owner signature: A(,\ Date: Z/j /. 401 amps to 599 amps 168.54 2 ❑ APPLI : I ❑ CONTACT PERSO Branch circuits new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: ..5(1-4/1 - B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit i3 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Address: L'��L Signal circuit(s)ena or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: - Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(,/z hr min) " ELECTRICAL!PERMIT FEES' ' ' :� Suprv.Electrician signature,required: Subtotal: Print name: i Date: ❑Plan Review Required(25%of permit fee): - State surcharge(12%of permit fee): Authorized signature: ��rV" TOTAL PERMIT FEE: �� This permit application expires if a permit is not obtained within 180 Print name: L.51-7 4 Dater 3 if- days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\'ermits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB e . Electrical Permit Application—City of Tigard Page 2—Supplemental Information • Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE * Fee for all residential systems combined: $75.00 Description I Qtr. I Each I Total I y Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less I00.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) _ ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(%]hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES I Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): ' Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Pennits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 Mechanical Permit Application FOR OFFICE USE ONLY Received City of Tigard _■CV iN Date/By: Permit No . • 13125 SW Hall Blvd.,Tigard,OR } Plan Review Phone: 503.718.2439 Fax: 503.59 Date/By: Other Permit: I I c i It I Inspection Line: 503.639.4175 _1 \S Date Ready/By: kris ® See Page 2 for cx Internet: www.tigard-or.gov � � Notified/Method: Supplemental Information AWN TYPE OF WOVEN v� .. 'MN - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST itt. r Mechanical p ermit fees•are based on the value of the work ANew construction ❑Addition/alt 6ftlent performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling ❑Commercial/industrial VI Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: J 059 0 S LA.) (u P( Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: T1 6A 0 R Furnace 100,000+BTU(ducts/vents) 54.91 ■ Q 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 C..eiti•JEAt. OF COOK .ArvE A'1-.(3 (A07-4 f KJ 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 i 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 • Flue vent for water heater or gas /MSTitz-L AT-7 GA.) OF 43Ay7t Pik S C2,,/ RAID fireplace 23.32 a V EST Log lighter(gas) 23.32 L -(o ; 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: J C..271- F)S-re4 Range hood/other kitchen equipment I 33.39 Address: OS9 O SW GOOK LR'^-E- Clothes dryer exhaust 33.39 City/State/ZIP: 71 6/4-e 5 C7& (5 7 2-73. Single-duct exhaust(bathrooms, 7 toilet compartments,utility rooms) 23.32 Phone:(5D3 ) 9 g -3 8 7.4 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: �f}rn tc 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: O o.. g.>2 Other MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%o of permit fee) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE I This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signatu • .J=` . Fee methodology set by Tri-County Building Industry Service Board Print name: ,,5'(p 77- Fj 1e. Date: 2 3 r 4( E x-r y ou NT -nve4 K s '4€A rE& I:1 Building\Permits\MEC_PmnitApp_0401I3.doc 440-46171(11/02/COMWEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 1 'Plum binQ Permit Application Building Fixtures �� FOR OFFICE USE ONLY Received City of Tigard Dateiv : Ycnnit No.. ■ 13125 SW Hall Blvd.,Tigard,OR UCVAIN Plan Review 1111 • Phone: 503.718.2439 Fax: 503.598.1960 p15 Date/By: Other Permit No. Inspection Line: 503.639.4175 8 3 2 Date Rea B tuns: ® See Page 2 for I IGARI) V Ready/By: K Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WO' , Oli VI�N , ■ FEE* SCHEDULE construction ■� s'�;,`�, For s'ecial in ormation use checklist a - Description Mil Ea. Total ❑Addition/alteration/replacement ■t New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78 Accessory building El Multi-family SFR(3)bath 500.32 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: Catch basin or area drain 18.76 OS� I� S Coo L�� Drywell,leach line,or trench drain 18.76 City/State/ZIP: "77 6 4.,t.0 0'' 572_23 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: no(J Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 4-,I_ IA.L.0 co O Rain drain connector 18.76 C Sanitary sewer(no.linear ft.:11() ) / Page 2 6,2 .pi Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear It.: ) Page 2 Subdivision: Fr4"I-7 s'y 1-41 c ._ I Lot no.: /3 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 as;CA- ADO.O N(1 Atli) 113 tl l AIN S 7(t (x)? Dishwasher I 25.02 ?S Drinking fountain 25.02 Ejectors/sump 25.02 tg(PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 c Fixture/sewer cap 25.02 Name: `�L�� oSi£,/� Floor drain/floor sink/hub 25.02 Address: /OS"0 Sul co 0 IC (Ares LE Garbage disposal 1 25.02 �s,0� City/State/ZIP: -r 6 iti 0 ' " '7�3 Hose bib 25.02 c �S�v1., Phone:($b3) ac 3�Z C 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: sfrt✓) Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 7 j-J1,0 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 /,? ,S 1 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 co-0y Water heater 37.52 .S). Business name: OW .-{- Water piping/DWV I 56.29 5-6,619 Address: (..S'/-,I1 ._.. Other: 25.02 City/State/ZIP: Subtotal 11�=s55- Phone:( ) Fax:( ) Minimum permit fee: $72.50 +�- Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%ofpermit fee) tir-7 Authoriied signature: TOTAL PERMIT FEE 1;1:5-6-341 Print name: SCet T R cCs,�� Date: 'L/. /1 r This permit application expires if a permit is not obtained w thin 180 days MJ ` after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pertnits\PLMU-PextnitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB) 1 r 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-I s`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 I� 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: 1 Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food 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: -LavBar 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 City of Tigard ■ COMMUNITY DEVELOPMENT DEPARTMENT TIr, P.D Building Permit Review — Residential Building Permit #: fi)STd-cDls--_. 0049(s Site Address: /Q ,0 Se ) 0001 LAfJ' Project Name: k_Q0/4-00).2 Lot #: (New uwe,ung=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: / /Yet( -7/j , moo Verify site address/suite #exists and active in permit system. S' e Flan Elements: / tv ee (3)copies of site plan 1,_,E sting structures on site ''A! it plan must}g on 8-1/2"x 11"or 11 x 17"paper LICFootprint of new structure(including decks)with finished l5 to scale(standard architect or engineer scale) fl or elevations arrow tility locations(required for new,may apply for additions) IYSi 3address,project or subdivision name and lot number cation of wells/septic systems plicant information(name and phone number) fc osion control(including drainage-way protection,silt fence t dimensions and building setback dimensions de .: ,location of catch basin,etc.) of area,building coverage area,percentage of coverage and street names pervious area(applicable if R-7,R-12,R-25&R-40) II. reet tre: .e and location roperty corner elevations(2 foot contour lines if more than V Kisting trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water, ervices—Service Provider Letter: (lot platted prior to 9/10/1995): Required: ls,applicant was notified Received: ❑ ,Yes No AV No ��and Use Case#: (t a['��G.i^(J e c V . aOl�- �� E Zoning: 1-3.s' lal Setbacks: Front Rear Side Street Side Hp) Garage Landscape Requirement: k1I b of Coverage Maximum: 10 :uilding Height: Maximum Height SC Actual Height Yi Visual Clearance (1 Sii Easements LA jensitive Lands: ❑ Yes ENo Type S>>U�rban Forestry Plan p�'t Conditions Met Notes: Approved By Planning: � W Date: -4-/S— Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:kBuilding\Forms\BldgPermitRvw_RES_100114.docx Building Permit Submittal Original Submittal Date: 0 Site Plans: # 4 Building Plans: # Building Permit#: b Enter building permit above. Workflow Routing: �7�P�nning L�Engineering 0--P6mtt Coordinator [—Bti ding Workflow Sign-off: Ell‘'-off for Planning(include notes from planning review) Route Application Documents: QV-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and on al plan review routing form. L i T uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: Engineering Review ❑ Actual Slope: ❑ Conditions Met ❑ Easements (encroachments) ❑ Water Quality/Quantity Facility: Assess Water Quality Fee: ❑ Yes ❑ No Assess Water Quantity Fee: ❑ Yes ❑ No Notes: Jo ae,.. a , iSS.4-1 S Approved by Engineering: Date: z, , f. Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions Met-Prior to Issuance of Building Permit Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: ;00K to Issue Permit Approved by Permit Coordinator: oLL/ Date: o3/47 I:\Build ing\Forms\B1dgPermitRvw_RES_l 00114.docx CITY OF TIGARD MASTER PERMIT liNII - ' COMMUNITY DEVELOPMENT Permit#: MST2015-00015 TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 03/02/2015 Parcel: 2S103DA05900 Jurisdiction: Tigard Site address: 10590 SW COOK LN Subdivision: FANTASY HILL Lot: 13 Project: FOSTER Project Description: 800 sq. ft.ADU addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 22 Bathrooms: 2 Second: 400 sf Garage: 0 sf Front 0 Smoke Dwelling Units: 2 Third: 0 sf Right: 0 Detectors: Yes Total: 800 sf Value: $90,000.00 Rear 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals. 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 40 SF Rain Storm Sewer 0 Tubs/Showers: 1 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: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<10OK: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders 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: 14 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: ACS SF VB R-3 800 Owner: Contractor: FOSTER,SCOTT A&LORRI K PREMIER PLUS CONSTRUCTION Required Items and Reports(Conditions) 10590 SW COOK LN PO BOX 441 TIGARD.OR 97223 HUBBARD,OR 97032 PHONE: PHONE: 503-951-2215 FAX: Total Fees: $3,663.93 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, •r if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of th-'igL—•r direct questions to OUNC by calling 5 ill:j •r .:'0.332.2344. Issued By: si�� ` Perm ee Signature: !Alek Cal 475 by 7:00 a.m.for the next available inspection•ate. 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. �� CITY OF TIGARD MASTER PERMIT N g • • COMMUNITY DEVELOPMENT Permit#: MST2015-00015 Date Issued: 03/02/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25103DA05900 Jurisdiction: Tigard Site address: 10590 SW COOK LN Subdivision: FANTASY HILL Lot: 13 Project: FOSTER Project Description: 800 sq. ft.ADU addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 22 Bathrooms: 2 Second: 400 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 2 Third: 0 sf Right: 0 Detectors: Yes Total: 800 sf Value: $90,000.00 Rear 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 40 SF Rain Storm Sewer: 0 Tubs/Showers: 1 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: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders 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: 14 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: ACS SF VB R-3 800 Owner: Contractor: FOSTER,SCOTT A&LORRI K PREMIER PLUS CONSTRUCTION Required Items and Reports(Conditions) 10590 SW COOK LN PO BOX 441 TIGARD,OR 97223 HUBBARD,OR 97032 PHONE: PHONE: 503-951-2215 FAX: Total Fees: $3,663.93 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, •r if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility requires you • r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of th r direct questions to OUNC by calling 5� e 1�' •r .:'0.332.2344. mi2e=1 ,......„.er,,a_.— 4111101.Id& Issued By: -------, 4.:- Perm ee Signature: Cal' 1'75 by 7:00 a.m.for the next available inspection•ate. 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. Al RECEIVED Information Notice to Owners About � . . Construction Responsibilities 3 2015 (ORS 701.325 (3)) UTVOFTIGARD sulLr"' re,”Tr[ C1^ Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to htto://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address: www.oregon.gov/ccb f/property_owner adopted 9-23-08 This Copy for Permit Applicant Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325(2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date r ri/A I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. cc3rr 'T Print Name of 'ermit Applicant Sii,''hirr 21-1/ S Signature o P= mit Applicant Date Permit#: /'),S7,-) Address: IOS.-/O1ir M 7�Q iv"( iR 7,2?] Issued by: /5.f Date: 3//3-- This Copy for Permit Offices ‘Ai= Residential Energy Additional Measure Selection RECEIVE])ECEIVEP Department of Consumer and Business Services •� • , Building Codes Division 5 g 1535 Edgewater NW,Salem,Oregon FEB 3 2015 Mailing address:P.O.Box 14470,Salem,OR 97309-0404 503-373-1210•Fax:503-378-3656 CITY OF TIGARD Web:bcd.oregon.gov BUILDING DIVISION RESIDENTIAL INFORMATION Date: I - le- lc- Building permit number: Owner's name: Se 0.it F5',F Job address: / 0S-1 0 S CJ C 0 O K 4.-4 e City: -1-16 Nth State: 0 ZIP: 4, 7.Z INSTRUCTIONS Please select type of construction below; sign, date, and complete the entire form. Submit this form with your permit application or your project will be placed on hold until the required information is provided. ❑ New construction.All conditioned spaces within residential buildings must comply with Table N1101.1(1)and two additional measures(one numbered and one lettered)from Table N1101.1(2)on page 2. Additions.Additions to existing buildings or structures may be made without making the entire building or structure comply if the new additions comply with the requirements of this chapter. (N1101.3) Large additions.Additions that are equal to or more than 40 percent of the existing building heated floor area or 600 square feet(55 m2)in area,whichever is less,must comply with Table N1101.1(2)on page 2. (N 1 101.3.1) (Note: You must select one numbered and one lettered measure.) ❑ Small additions. Additions that are less than 40 percent of the existing building heated floor area or less than 600 square feet in area, whichever is less,must select one measure from Table N1101.1(2)on page 2 or comply with Table N1101.3 below. (N1101.3.2) ❑ Exception: Additions that are less than 15 percent of existing building heated floor area or 200 square feet(18.58 m2) in area,whichever is less,are not required to comply with Table N1101.1(2)or Table NI 101.3. Selected item number: Selected item letter: Note:Depending on which Additional Measures you have selected, there may be sub-options that you will have to specify. Check the appropriate box if provided. Applicant's signature: Print name: TABLE NI 101.3–SMALL ADDITION ADDITIONAL MEASURES(SELECT ONE) ❑ 1 Increase the ceiling insulation of the existing portion of the home as specified in Table N1101.2. ❑ 2 Replace all existing single-pane wood or aluminum windows to be U-value as specified in Table N 1 101.2. Insulate the floor system as specified in Table N1101.2 and install 50 percent of permanently installed lighting fixtures ❑ 3 as CFL or linear fluorescent or min.efficacy of 40 lumens per watt as specified in Section N1107.2. ❑ 4 Test the entire dwelling with blower door and exhibit no more than 7.0 air changes per hour @ 50 Pascals. ❑ 5 Seal and performance test the duct system. ❑ 6 Replace existing 78 percent AFUE or less gas furnace with a 92 percent AFUE or greater system. ❑ 7 Replace existing electric radiant space heaters with a ductless mini-split system with a minimum HSPF of 8.5. ❑ 8 Replace existing electric forced air furnace with an air source heat pump with a minimum HSPF of 8.5. ❑ 9 Replace existing water heater for a natural gas/propane water hear with a minimum EF of 0.67. ❑ 10 Install a solar water heating system with a minimum of 40 square feet of gross collector area. miArgeF 5 RVI 440-4854(8/12/COM) Page 1 N Residential Energy Additional •`lc� Measure Selection RECEIVEI)Department of Consumer and Business Services Building Codes Division 1535 Edgewater NW,Salem,Oregon FEB 3 2015 Mailing address:P.O.Box 14470,Salem,OR 97309-0404 503-373-1210•Fax:503-378-3656 CITY OFTIGARD Web:bcd.oregon.gov BUILDING DIVISION RESIDENTIAL INFORMATION Date: I— �— S Building permit number: Owner's name: _SC 0 TT r-;.,gr� Job address: 1 Cog-c]0 S GJ C O o K c_lh City: Y1 t,ARPI State: 0 fc ZIP: 4, 7 2 INSTRUCTIONS Please select type of construction below; sign, date, and complete the entire form. Submit this form with your permit application or your project will be placed on hold until the required information is provided. ❑ New construction.All conditioned spaces within residential buildings must comply with Table N1101.1(1)and two additional measures(one numbered and one lettered) from Table N1101.1(2)on page 2. Additions.Additions to existing buildings or structures may be made without making the entire building or structure comply if the new additions comply with the requirements of this chapter.(N1101.3) Large additions.Additions that are equal to or more than 40 percent of the existing building heated floor area or 600 square feet(55 m2)in area,whichever is less,must comply with Table N1101.1(2)on page 2. (N1101.3.1) (Note: You must select one numbered and one lettered measure.) ❑ Small additions. Additions that are less than 40 percent of the existing building heated floor area or less than 600 square feet in area,whichever is less,must select one measure from Table N1101.1(2)on page 2 or comply with Table N1101.3 below. (N1101.3.2) n Exception: Additions that are less than 15 percent of existing building heated floor area or 200 square feet(18.58 m2) in area,whichever is less,are not required to comply with Table N1101.1(2)or Table N1101.3. Selected item number: Selected item letter: Note:Depending on which Additional Measures you have selected, there may be sub-options that you will have to spec. Check the appropriate box if provided. Applicant's signature: Print name: TABLE N1101.3—SMALL ADDITION ADDITIONAL MEASURES (SELECT ONE) ❑ 1 Increase the ceiling insulation of the existing portion of the home as specified in Table N1101.2. ❑ 2 Replace all existing single-pane wood or aluminum windows to be U-value as specified in Table N1101.2. Insulate the floor system as specified in Table N1101.2 and install 50 percent of permanently installed lighting fixtures ❑ 3 as CFL or linear fluorescent or min.efficacy of 40 lumens per watt as specified in Section N1107.2. ❑ 4 Test the entire dwelling with blower door and exhibit no more than 7.0 air changes per hour @ 50 Pascals. ❑ 5 Seal and performance test the duct system. ❑ 6 Replace existing 78 percent AFUE or less gas furnace with a 92 percent AFUE or greater system. ❑ 7 Replace existing electric radiant space heaters with a ductless mini-split system with a minimum HSPF of 8.5. ❑ 8 Replace existing electric forced air furnace with an air source heat pump with a minimum HSPF of 8.5. ❑ 9 Replace existing water heater for a natural gas/propane water hear with a minimum EF of 0.67. ❑ 10 Install a solar water heating system with a minimum of 40 square feet of gross collector area. 9cIv 4 40-4854(8/12/COM) Page 1 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10590 SW COOK LN, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2015-00015 David Young Provide breaker lock for dishwasher. All else ok. 422.31 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10590 SW COOK LN, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL April 4, 2016 at 11:45:28 AM MST2015-00015 David Young Fix leak at lower level main lav. 310.4 All else ok. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10590 SW COOK LN, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00015 David Young Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10590 SW COOK LN, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS April 7, 2016 at 9:54:46 AM MST2015-00015 David Young Correction complete. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10590 SW COOK LN, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal PASS April 7, 2016 at 9:57:34 AM MST2015-00015 David Young Correction complete. Violation Summary: Inspector Contractor