Permit EXPIRED RED
Building Permit Application -3l,7 �(� --
, ‘
Residential RECEIVED IOR()I I l( I l 'l 0\l 1
City of Tigard AUG 7 2013 eBy t 7 /3 igilit...."'Permit NW57-620/3 mal/4
114 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
■ Phone: 503.718.2439 Fax: 503.598.19 Plan Re
: Other Permit:
Inspection Line: 503.639.4175 �� T�GARD Date ReadyBy: g2
t I t; 1 R f 1 BUILDING DIVISION rpt See Page for
Internet: www.tigard-or.gov Notified/Method: /(� Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ `O( —
1:1Accessory building 0 Multi-family Number of bedrooms: 1
❑Master builder ❑Other: Number of bathrooms: I
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:12944 SW Wilmington Ln New dwelling area: 682 square feet
City/State/ZIP:Tigard/Oregon/97224 Garage/carport area: square feet
Suite/bldg./apt.no.:NA Project name:Goble Basement Upgrade Covered porch area: square feet
Cross street/directions to job site:Ridgefield Deck area: square feet
99 to Garde,right on Greenfield,right on Ridgefield,left on Wilmington Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Flushed the unfinished portion of basement,including bedroom,bathroom,laundry Valuation: $
closet,den,bar and storage rooms. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Bob Goble o Type of construction:
Address:12944 SW Wilmington Ln �✓7�3—� p g g(77 n Occupancy groups:
City/State/ZIP:Tigard/Oregon/97224 r`j/�tVIL)C Lai") Existing:
Phone:(503)524.7395 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:NA (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Bob Goble
FLS plan review fee(if applicable):
Address:12944 SW Wilmington Ln
City/State/ZIP:Tigard/Oregon/97224 Total fees due upon application:
Amount received: /.../T, L /V
Phone:(503)524.7395 Fax::( ) ��
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:NA Ou.JE . Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature: tA ` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Pal *Fee methodology set by Tri-County Building Industry
1\t{, ��� Date: /_7//..3Service Board.
I . I
EXPIRED
Plumbing Permit Application
Building Fixtures R� j ��� I c11z 01.1 is 1- 1 ‘,I 0v1_1
City of Tigard AUG 7 2013 Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223III Date/By:Recei"ed
Plan Review
= Phone: 503.718.2439 Fax: Other Permit No.:
503398.1966TV OFTIGARD Date/By.
Inspection Line: 503.639.4175
t'A I) Date Ready/By: Juris: 0 See Page
2 for
Internet: www.tigard-or.gov DUI DttIG DIVISION Notified/Method:
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:12944 SW Wilmington Ln Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Goble Basement Upgrade Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
99 to Garde,right on Greenfield,right on Ridgefield,left on Wilmington 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:Wilmington Heights I Lot no.:8 Fixture or item:
Tax map/parcel no.:2519AA-03400 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
Finshed the unfinished portion of basement,including bedroom,bathroom,laundry Dishwasher 1 25.02 25.02
closet,den,bar and storage rooms Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Robert Goble Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12944 SW Wilmington Lane Garbage disposal 1 25.02 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(503)524-7395 Fax:( ) Ice maker 1 12.51 25.02
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:na Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Robert Goble
Roof drain(commercial) 12.51
Address: 12944 SW Wilmington Lane Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:Tigard,OR 97224 Solar units(potable water) 62.54
Phone:(503)524-7395 Fax::( ) Tub/shower/shower pan 1 12.51 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 1 25.02 25.02
Water heater 37.52
Business name: ea/Al-E ._ Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 187.65
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: / Plumbing Lic.no.: Plan review (25%of permit fee) 46.91
State surcharge(12%of permit fee) 5.63
Authorized signal;
TOTAL PERMIT FEE 240.19
Print name: �j 15 Pte p `Date: T /3 This permit application expires if a permit is not obtained within 180 days
I V after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
, , e
Mechanical Permit Applicata F()at t>1I�I, ► a .a ()N1.,
City of Tigard �� �� ,: Received
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review a
' I Phone: 503.718.2439 Fax: 503.598.1960 AUG 7 2013 Date/By: 1 L Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
n�,-��.a ady y�
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WtnII-DING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For spec/ui information use checklist.
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AM) LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:12944SW Wilmington Ln Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard/Oregon/97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:NA Project name:Goble Basement Upgrade Duct work 7 23.32 163.24
Cross street/directions to job site:Ridgefield Hydronic hot water system 23.32
Residential boiler(radiator or
99 to Garde,right on Greenfield,right on Ridgefield,left on Wilmington 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Finshed the unfinished portion of basement,including bedroom,bathroom,laundry fireplace 23.32
closet,den,bar and storage rooms. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Bob Goble Range hood/other kitchen
equipment 33.39
Address: 12944SW Wilmington Ln Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Tigard/Oregon/97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2 23.32 46.64
Phone:(503)524.7395 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:NA Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Bob Goble Furnace,etc.
Address:12944SW Wilmington Ln Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard/Oregon/97224 Water heater
Phone:(503)524.7395 Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:NA tJ A7A/16 _
MECHANICAL PERMIT FEES*
Address: Subtotal 243.27
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee) 60.82
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 29.19
CCB lie.: TOTAL PERMIT FEE 333.28
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized s a * Fee methodology set by Tri-County Building Industry Service Board
,
Electrical Permit ApplicationR EC E l VD ► u►z 0, l l( ,_ , ,► O\1.1
Cityof Tigard Received
g
Date/13y: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review EXPIRED'�-
Phone: 503.7182439 Fax: 503.598.19 Date/By: Other Permit:
I. 1\i Inspection Line: 503.639.4175 ��AUG 7 2 013
ITh \ TY OF TIGAR D Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVIS!OI~' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more 0 Building over three stones.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 12944SW Wilmington Ln 100HSix or or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard/Oregon/97224 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:NA Project name:Goble Residence Upgrade 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Ridgefield Description ' I Qty. I Fee. ' ( Total I •
New residential single-or multi-family dwelling unit.
99 to Garde,right on Greenfiel,right on Ridgefield,left on Wilmington Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'►500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Finshed unfinished portion of basement,including bedroom,bathroom,laundry/ residential(with above sq.ft.)
Renewable Energy 0 See Page 2
closet,bar and storage rooms. Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Robert Goble 401 amps to 600 amps 200.34 2
Address: 129944 SW Wilmington Ln 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard/Oregon/97224 Temporary services or feeders installation,alteration,and/or
Phone:(503)524.7395 Fax:( ) relocation
200 amps or less 59.36 1
Owner installation: 's installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
/ intended for sale,le r;rent,or exchange,according to ORS 447,449,6701,rtd 791• 401 amps to 599 amps 168.54 2
f� Owner signature: i t / -' Date: 1/ /3 Branch circuits—new,alteration,or extension,per panel
® APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:NA each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Robert Goble service or feeder fee,first 1 56.18 56.18 2
branch circuit
Address: 12944SW Wilmington Ln Each add'I branch circuit 9 7.42 66.78 2
City/State/ZIP:Tigard/Oregon/97224 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)524.7395 Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:NA D A/A/C=�_ Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Clty/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) 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(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 122.96
Print name: Date: Plan review(25%of permit fee): 30.74
State surcharge(12%of permit fee): 14.76
Authorized signature: TOTAL PERMIT FEE: 168.46
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
I
RECEIVED
Property Owner Statement Aug 8 2013
CITYTIGARD
RegardingConstruction Responsibilities BUILDINGDIV
ISION
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 per mits.
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
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
Nt. MF I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
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.
?A-while V /,c,3v
Print Name of Permit Applicant
g/ VI3
ignature of Permit Applicant Date
Permit#:
Address:
.142, •
Issued by: Date: 1-14:
This Copy for Permit Offices